From the Granite State News Collaborative and NH PBS - The State We're in.
Host Melanie Plenda discusses staying healthy this school year with pediatric infectious disease expert Dr. Cody Meissner.
Click the link to watch the full interview on NH PBS's The State We're In.
This content has been edited for length and clarity. Watch the full interview on NH PBS's The State We’re In.
Melanie Plenda: As kids head back to school, what should parents keep in mind? What should they be looking out for? How can they be prepared, especially as the weather changes? What should they be watching for and be prepared to do once their kids head back?
Dr. Cody Meissner: I think we've learned a lot from this pandemic. One of the most important factors that we've learned is that this pandemic, unlike most infections, is an illness of the elderly. The higher in age a person is, the greater the likelihood that that person will experience a severe illness. Conversely, the younger a person is the less likely it is that a child will experience a severe infection. We can say for example, that probably 75% of the deaths occurred in individuals over 65 years of age. A tiny fraction of the deaths have occurred in individuals under 18 years of age, so I think it's important for us to rethink this whole issue. We know number one, that vaccines will not prevent infection. They're very effective at preventing severe disease, but we know that that a person who has been appropriately vaccinated is still going to be infected.
One of the lessons we've learned is that we will never get herd immunity against this particular Coronavirus the same way that we get herd immunity against a measles virus. That is, if a child or an adult has been vaccinated against measles, they are not going to be infected and will not transmit it, but that's not going to be the case with any of the Coronaviruses, and particularly the Coronavirus that's causing this pandemic. If you are vaccinated as recommended by the CDC, you will very likely be protected against a severe illness. You will very likely not have to go to the hospital. You will not go into the intensive care unit. You will not be intubated. Except perhaps for people who have what we call comorbidities, someone who has had an organ transplant or a person who's receiving chemotherapy, their immune system doesn't work very well in response to the vaccines so that's a different scenario.
There is work going on, some of it here at Dartmouth, about nasal vaccines or topical vaccines. If we can immunize the mucus membranes of our nose and sinuses against this virus, then the vaccine may prevent infection. That would be the best of all possible worlds, but with the current generation of vaccines, we're not going to reach that that very desirable endpoint. We had to prepare for the fact that this virus is going to be around.
Now, in regard to children, I think we've learned that it's not possible to screen for a person who might be infected by checking a temperature. Some schools have elected to do check temperatures, but I think it's become very clear that many people who are infected and capable of transmitting the virus do not have a fever and in fact, they feel very well. That's one of the reasons that this virus has been so insidious, because people are spreading it and they don't even know it. They don't know that they're sick, that doesn't happen for several days after it's possible for them to spread the virus. That's what's made this pandemic so difficult to control. The way this virus is spread is by coughing and sneezing and even talking to a person who may be symptomatic or asymptomatic. We're coming to realize that we're going to have to live with this virus.
We can use all the precautions that we want, but what is really important are things like ventilation. We know that transmission of this virus is almost exclusively something that happens indoors. People do not catch this virus if they're outdoors so the more classes you can have outside the better. The windows should be open to the classroom so that there's breeze and ventilation. What that does is simply blow away the virus that some people are going to be shedding, but I think we have to understand that there will be people who are perfectly healthy who will be positive. I don't think that's a reason for great alarm. That's just going to be the pattern that this virus follows. It's the same thing that other respiratory viruses do that cause the common cold.
Melanie Plenda: Let's shift a bit and talk about monkeypox. Can you give us a brief background about monkeypox? What exactly is it and why is it a concern?
Dr. Cody Meissner: We've known about monkeypox for more than 50 years. It's a member of a class of viruses called pox viruses. Everyone has probably heard of smallpox. Smallpox has been officially eliminated from the globe with the use of the smallpox vaccine. It's one of the great miracles of modern medicine. Monkeypox is a disease that almost never occurred in the United States until a few months ago. It's a disease that's primarily in the countries in Central Africa.
We had an outbreak a few years ago in the United States when there were some animals that were shipped to the United States and they infected some animals that were then distributed around the country as pets, but humans can get infected. The CDC has helped us learn a lot about monkeypox in a very short period of time. We know that this is a disease that's almost exclusively occurs among men who have sex with men. It's more than skin to skin contact. There seems to be some involvement with sexual activity.
It can occur in women if they have sexual activity with a man who is infected. However, this is very different than the last virus we were talking about. The coronavirus is spread by people who don't know they're infected. Monkeypox is only spread by people who know they're infected. It's exclusively comes from those round blisters that are filled with pus. If that gets onto someone else's skin, that's how this virus is transmitted. Right now, 95% of the people in the United States who've been infected have indulged in a particular activity which has placed them at risk. There have been some cases described in children. It's not quite clear how they might have acquired the infection, but parents should not worry about this. This is not going to be a disease of children or a disease of adults who don't participate in certain practices.
Melanie Plenda: It has been mischaracterized as a sexually transmitted disease, but that is not the case, correct?
Dr. Cody Meissner: It depends on how you want to describe a sexually transmitted disease. It is transmitted between men who have sex together. It is spread by sexual activity. It’s not going to be spread among heterosexuals, and a person has to have a rash in order to be infectious to other people.
Melanie Plenda: Vaccination has become polarizing in the last few years. In your experience, is it limited to COVID-19 or are people, especially parents, refusing other vaccinations as well?
Dr. Cody Meissner: Our immunization rates in the United States are excellent; more than 95% of the children in the United States are fully immunized according to the current recommendations from the CDC, and we immunize against 16 different infectious diseases. There have always been people who were against vaccines. Ever since Edward Jenner first developed a smallpox vaccine 250 years ago, there were people who didn't want to accept any vaccine. It's important to draw a distinction between people who have always been against immunizations and individuals who show some hesitancy to the COVID-19 vaccine.
I personally don't agree with that decision and I would like to be able to dissuade them from that opinion, but that's very different because almost all parents are willing to vaccinate their children against measles, mumps, rubella, meningitis, and pneumonia. The reason that we enjoy such a wonderful standard of health in the United States is probably more because of immunizations than because of anything else. What people who don't want to accept vaccines oftentimes forget is that the germs that cause these diseases are around all the time.
We've forgotten about how deadly measles is because we don't see it anymore. Measles is a terrible, terrible disease and no one wants to get measles or any of these vaccine-preventable diseases. Many people who have been reluctant to get the COVID vaccine are not reluctant to have their children get all of the recommended vaccines. The most recent data from the CDC shows that among 5 to 11 year old children only 30% have been vaccinated against COVID-19 and over 95% have been vaccinated against all the other vaccines. I think that they should discuss that with their physician and read about it and come to understand that it really is a safe vaccine, but I like to keep it in a different category than the regular vaccines.
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