What is HPV and RSV?

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Transcript

Chrissy Billau:
Welcome to prescribed listening from the University of Toledo Medical Center. On this podcast, we interview our experts to get the answers you need and can trust I'm your host, Chrissy Billau. And today we are diving into some of the top Googled health questions from 2020 and 2021 with Dr. Deepa Mukundan who works in pediatrics and infectious disease as a University of Toledo physician. Thank you for joining us.

Dr. Deepa Mukundan:
Thank you.

Chrissy Billau:
Throughout the COVID-19 pandemic, we've heard concerns about the growing risk of RSV and HPV in children and adults. And naturally you want to find out, "How do I protect my family?" So let's ask the expert, Dr. Mukundan, here are two of the top Googled health questions. What is HPV? And what is RSV? And let's start with RSV. What is it? And why have medical professionals been concerned about COVID-19 and RSV?

Dr. Deepa Mukundan:
So RSV, the long term is respiratory syncytial virus. It's a virus that causes respiratory infections. More so in little children, it can cause serious, lower respiratory infections. So in the context of COVID-19, the issue is both our respiratory viruses and were we to have both viruses together, which will take over, would there be more problems or less problems? So those were the issues we were trying to understand. Fortunately, during the first year of the COVID pandemic, we did not see any virus. So any other viruses other than COVID. So that was not an issue.

Dr. Deepa Mukundan:
Currently as the COVID pandemic is sort of, I wouldn't say coming under control, we are sort of getting used to it and we have some ways of dealing with it. Other viruses are popping up again. We did have a reasonable, I would say a moderate, RSV season last year with some serious infections. And it's usually children who are less than two years of age, who get admitted with RSV infections in the hospital because they find it difficult to breathe and they just need to tide over and we help them tide over the viral infection.

Chrissy Billau:
It's obviously everybody getting back out and about things start going around again. Did people getting COVID-19 and RSV at the same time?

Dr. Deepa Mukundan:
Not really. We had a few in the hospital. We never really saw that much of an effect in the real world.

Chrissy Billau:
Okay. Okay. Is RSV a disease only a child can get?

Dr. Deepa Mukundan:
No. So RSV viruses, everybody can carry the viruses. It's a virus that's carried only by humans. No other species carries it. Serious infections. Everybody can get a respiratory infection due to RSV, but serious infections are usually seen in the very young, up to two years of age at the most. And then you can see it in the elderly who have other major problems like respiratory problems or heart problems. But predominantly it is seen as a disease that causes serious problems in young children.

Chrissy Billau:
Okay. And for getting through the COVID-19 pandemic, when it started going around again, was RSV a bigger issue in older patients, in seniors?

Dr. Deepa Mukundan:
I did not see that either. That was not reported. Although I'm a pediatrician I'm in tune to all the viruses that circulate. I don't think that was a big issue either during the COVID pandemic in the elderly.

Chrissy Billau:
Okay. Got it. So what are some steps to avoid getting RSV as an adult or a child?

Dr. Deepa Mukundan:
So some steps are, if anybody has a cough, cold, or fever, mainly a cough and cold, cover your cough and then wash your hands. So the main modes of transmission is if you're in close contact with a person and you cough and the droplets fall on the other person's nose or eyes or mouth, then you get the infection. RSV virus can also hang out in external surfaces in the environment, on our hands for about three hours, two to three hours. Maybe on what we call is fomites, which would be door handles, tables, clothes for a few more hours. So if anybody comes in contact with that and then touch their eyes and face, then they can get the respiratory infection. So contact and droplet are what we call as major modes of transmission. Contact more than droplet.

Chrissy Billau:
As a pediatrician. What are ways that you talk to kids about being able to just take care of yourself for RSV in the time of COVID-19? I mean, because they're children. And you, "Wash your hands."

Dr. Deepa Mukundan:
Right. Well, less than six months, it's the parents. So parents have all the control. So parents need to wash their hands before and after handling the child or secretions themselves. So hand washing is extremely important. Cover your cough is extremely important. Now when it comes to older children, it is just a little hard because developmentally they are ... you have to be very persistent with them. But at the same time, not too persistent that they become very defiant. So there's an art to dealing with a child. And during the pandemic everybody's patience also were thin, so that can be a challenge as well. So essentially, being aware, being observant, having all the adults, at least not cough into somebody's face, and covering their cough, and washing their hands. And then dealing with the child without being too obsessive would really help.

Chrissy Billau:
Okay. Well, let's switch to HPV. What is it? And why have medical professionals been concerned about COVID-19 and HPV?

Dr. Deepa Mukundan:
That's interesting. HPV is a sexually transmitted disease and we see it more so in adolescents and young adults. It's seen as a virus that can cause infections that are not very symptomatic, but it's usually the long-term issues that is associated with HPV is a concern for us medical professionals, which is cervical cancer. Maybe a little earlier would be genital warts. So it's an infection that is not symptomatic, that's sexually transmitted, which can cause angst amongst individuals because there's no way for them to know whether they have HPV or not, whether their partner has HPV or not, unless there are obvious genital [inaudible 00:07:18] sores there.

Dr. Deepa Mukundan:
It can also be transmitted by oral sex, vaginal sex. Most commonly it's vaginal sex, but oral sex. And then long term effects are nasopharyngeal cancers. The only mode of prevention, currently, is vaccine. So vaccines have decreased. And the outcomes, what we have looked at, based on vaccine administration, is decrease in the incidence of cancers, which has dramatically decreased in women, especially cervical cancers. And for men, as more men get immunized, they also tend to decrease the number of nasopharyngeal cancers. So between COVID-19 and HPV, the link is probably ... We have seen a rise in sexually transmitted diseases after COVID-19 or during COVID-19. And HPV is one. And unfortunately, since there are no symptoms associated with it that can raise an angst. So the best way is to get immunized.

Chrissy Billau:
Okay. And I read that ... Well, the HPV vaccine was introduced in 2006, 16 years ago. And there was a study that shows the pandemic has led to fewer adolescents being vaccinated against it. Is that just a part of ... you think people just didn't want to go to the doctor at the time, you wanted to stay at home, or a rise in maybe people not wanting to get vaccinated for anything?

Dr. Deepa Mukundan:
I think it's multifactorial. During the lockdown, nobody got vaccinated. So it sort of went to the back burner and after the lockdown also getting people back to the offices was a challenge. We did. And the same thing occurred with young children getting vaccinated. I mean the rates of measles vaccination, varicella vaccination have also decreased. And what we have seen in those who get vaccinated, it's the challenge is much less with young children getting vaccinated versus adolescents. Adolescents, there may be some behavioral issues as well of coming to the doctor, getting their shots. And overall, if you look at vaccination rates, the adolescent vaccination rates, especially for HPV and other vaccines, is much less compared to infant getting vaccinated.

Dr. Deepa Mukundan:
So that is one. And number two is, adolescents are seeing what's happening in the real world. And they're questioning as to why should we get vaccinated? And sometimes they do not have the ability to look 10 years down the road, 20 years down the road. It's now and done. So communication is a big way of getting past that barrier. So I would say it's multifactorial getting vaccinated in the adolescent population. Even without COVID it was a challenge. With COVID it's an additional challenge.

Chrissy Billau:
So how can you protect your child and yourself from HPV? What can parents be doing for their children right now?

Dr. Deepa Mukundan:
So parents can get the children vaccinated. But what I have seen is if you have open communication with your child, you are able to bring that child to the physician and get them vaccinated and have them do all the right things in terms of preventive care. If those communication channel is a challenge, then it becomes a battle and that's a huge barrier. So I would say, first of all, don't make it a dichotomous idea. Start the conversation, get educated yourself, then educate your child about it and walk them through the whole process.

Chrissy Billau:
Well, it's difficult enough to talk to your kids about sex and then adding a vaccine to protect yourself long-term from something that can come from it.

Dr. Deepa Mukundan:
Yes. And at least, luckily, we don't have to do the whole thing. We can just say it's a sexually transmitted disease that's available in older children. One thing, at least for me, it was easy because when I told my son, "You have to get vaccinated. He used to ask which one." So I hope you have such a relationship with your children, too. And try to develop that. I know it has been a challenge during COVID. I mean, everybody has cabin fever now. So hopefully things are getting better with the summer season. But that communication is extremely important.

Chrissy Billau:
How young can you get the HPV vaccine?

Dr. Deepa Mukundan:
It's recommended at around 11 years of age. 11 to 13 is the first shot. That's what the CDC has requested that we do. That's because if you were to get them before they become sexually active, there's some amount of immunity can prevent many infections. Once they're sexually active and you're already infected, there is still some benefit to it, but you want to get them before.

Chrissy Billau:
Okay. Okay. Well, the conversation overall seems to be underlying the importance of making sure your children are caught up on their vaccines. What do you say to the patient's parents who are saying no vaccines for my kid?

Dr. Deepa Mukundan:
It's a challenge we've been facing. It's nothing new, but more so after the COVID vaccine. It has sort of progressively been increasingly become a challenge over the years. We have developed educational strategies, conversation strategies, to discuss with parents. And the most important thing is to not to judge them because we don't know where they're coming from. They may have really good reasons. And the other thing is for us not to force it on them. Tell them what the data is. Sometimes it's difficult to understand science. So we walk with them and it may be a multiple stage process of conversations before they decide to take the vaccine. I've had parents who have come to me and said, "I really want to vaccinate my child, but these are the questions I have. Do you have answers for them? What are the answers?"

Dr. Deepa Mukundan:
And I may not have answers for all of them. But just walking in their shoes and having that back and forth conversation and educating them does help a lot. It does take time. And in today's world when we are running. Why can't you just listen to us? No, that doesn't really happen. Just like an adolescent child. So we do have to have those conversations. And parents do trust their primary care physicians because they have a long -term relationship. And they've trusted their most important, their precious child, with the primary care physician. So if a primary care physician is able to lead them through that process, I think that's the best way to do it.

Chrissy Billau:
Is there actually a considerable number of families choosing not to vaccinate?

Dr. Deepa Mukundan:
Not really, but they get the loudest voice because we tend to spend more time. It's a squeaky wheel that gets the oil. Right? Currently the infant vaccination rates after the COVID pandemic, it depends on the area, it's about in the 70% range. So do I think that the 30% do not want to get vaccinated? Not really. It's just that they haven't gotten back to seeing their physician again. And they're having a lot of challenges during post pandemic. So we have to just be a little more patient with them. There is a small minority, about 2 to 3%, which we had even before the pandemic, who would definitely not get vaccinated irrespective of what conversations you have with them. And the challenge is to keep them in the loop. That's it. And work with them.

Chrissy Billau:
What is a good resource if someone doesn't want to go into the doctor? What is a good resource? Something that they can Google to look up, to get some answers to their questions about vaccines or HPV or RSV? Where do they look for good reputable advice?

Dr. Deepa Mukundan:
Yeah. So the education resources, one good place is your local health department because they will be tuned to your local issues. The other one nationally is Centers for Disease Control. They have good patient information. And read through it carefully and understand it carefully. And again, have those conversations with your primary care physician.

Chrissy Billau:
Not social media.

Dr. Deepa Mukundan:
No. Social media likes to alarm you, I would say, because they want your set of eyes on their information. And it's a profit based entity. So the more eyes they get on it. So essentially they like to alarm you about various things.

Chrissy Billau:
Okay. Okay. Now you mentioned this before, we hear about outbreaks of measles or other illnesses coming back. Is that a legitimate concern or those blown out of proportion?

Dr. Deepa Mukundan:
It depends on who you listen to. So it is a legitimate concern. But what I see is when people want that concern to be raised to a certain level, then it gets blown out of proportion. So always moderation is the best way to get your message through, just state the facts, state the numbers, and state what the problems are. And understand the other side. I think that's what's important, communicating with a steady voice and a steady [inaudible 00:17:44].

Chrissy Billau:
Well the same with hepatitis cases we're hearing about. Is this something that should be alarming? Or is it like the measles where depends on-

Dr. Deepa Mukundan:
The hepatitis cases. Okay. The number of cases are not that many, but at the same time, the severity of illness is pretty severe when they go into a small population of those children. So the CDC raises the awareness to physicians to tell them, "If you're seeing any of these patients, we want to know more about it so that we can get to the bottom of it." Because as a single physician, we cannot get to the bottom of one patient. So as a nationally, we should have a conversation. But what happens when we have a national conversation, is it takes, what do you call it, a shape of its own, so then the alarm is raised.

Dr. Deepa Mukundan:
Hepatitis viruses are generally foodborne viruses, but I don't know whether this is really a viral illness. At this point, we think it could be because majority of the children are. But do I need to alter the way I live? No. Wash your hands, keep your house clean, do all what you normally do, cover your cough. And make sure what you eat is healthy and appropriate in terms of not contaminated food and you wash and cook appropriately. So there is no cause for alarm to change things. But at same time, we do want to know if those things happen. I can understand a little bit of angst. So sometimes I just switch off my cable news.

Chrissy Billau:
Well, I want to switch out at talking about everyday stuff. For parents of kids in school, when your child gets a respiratory thing, when should you get your child tested for COVID-19?

Dr. Deepa Mukundan:
That's an excellent question.

Chrissy Billau:
Because I've experienced this.

Dr. Deepa Mukundan:
I do understand that. Yes. At this point there's a lot of confusion. It depends on the school's policy. Schools do want kids who are symptomatic to be tested. And the school policy is based on what the community wants, right, that community of children want. Not everybody wants the same thing. So in today's environment with where we are with the pandemic, probably that'd be the right thing to do. Because if the child goes back to school and there are other children who have other problems, which can cause severe COVID, you want to probably isolate this child, right, and not spread the infection. At this point, that's what I would do, test and isolate till things change.

Chrissy Billau:
Okay. And looking ahead to children going back to go school in the fall, what should parents be considering for their kids? I don't know if we can tell where we're going to be at that point or do they need to wear masks? What needs to be on their radar for going back to school?

Dr. Deepa Mukundan:
So in terms of infectious disease as a whole, I would say make sure your children are all up to date with their vaccines. Make sure you encourage some good habits in terms of hand washing, covering your cough, telling if you're symptomatic, even if you have to miss the most important thing in life, so that you isolate yourself and not spread the infection. So encourage those habits. And temper the expectations in terms of we could have a bad season, we could have a good season. Hope for the best, but be prepared for the worst. And follow the CDC recommendations or your statewide recommendations.

Dr. Deepa Mukundan:
What I normally do every day is I look at what's the risk of COVID in my community. The risk is measured by the number of COVID positive patients in the community. And if the risk is high in the community, I would avoid some indoor gatherings. If I had planned a get together with my friends in an indoor setting, I would tell them ... I mean, most of them are vaccinated so that's not a concern, at least in my group. So if you are going to be with unvaccinated folks, you may want to tell them to get vaccinated or, "The community risk is high. Maybe we should just not do it. Let's do it at a different time, maybe in an outdoor setting." So having a measured response to what's going on, which means that you understand the reality of the issues and you may not get all what you want.

Chrissy Billau:
Well, I know. What's interesting is looking at the rate in your community, the positivity rate, with the at-home tests, if you get a positive rate, I mean you tell your employer and you're at home. But does it go on the full numbers for your community? Because I don't even think when I had it in January, I didn't call my doctor. I was like, "I have it. I'm home."

Dr. Deepa Mukundan:
Right. I get that question a lot. At this point, the CDC does not recommend that you report that. They say look at your local community health department and see whether they want you to report it. The CDC also has an information sheet if you want to communicate it to the people you have been in close contact with. Say you were in a get together or things like that. And you can do it either anonymously or you can just call your friend and say, "Hey, I tested positive. We were together for the-" It just depends on your comfort level. So the CDC has facilitated that process.

Dr. Deepa Mukundan:
The third thing is, look at your state health department information and also call your primary care physician. In the midst of all what's going on in the medical world, I don't know whether they will directly ... they have a process to directly report to the state health department. And resources are limited now. So what we achieve by home testing is we want people to be stewards of their own health and of their community, so they can isolate themselves, inform people who are around them, and decrease their transmission. So a lot of the onus is now on the individual more than coming from outside.

Chrissy Billau:
Okay. Well, and one thing I want to talk about with kids, if this hasn't already been drilled into their heads, how do you ensure that they wash their hands? Is there something magical that you tell your patients?

Dr. Deepa Mukundan:
It's by role modeling? There is no other way. I mean, there are a lot of YouTube videos in the beginning of the pandemic where you saw toddlers washing their hands, doing the hand sanitizer. They go by imitation. So if adults role model that behavior, they will follow you. And don't force it on them.

Chrissy Billau:
Okay. And now piggybacking on the Google searches, I want to ask you Dr. Mukundan, what is the most common question you get from patients and what is your answer?

Dr. Deepa Mukundan:
Okay. The most, most common question I get from patients is, "Should I get COVID vaccine or not? Is it safe?" And my answer is, "Yes, you should. Is it hundred percent safe? It has adverse events. You can get a fever, you can get an arm ache, you can get lymph nodes, you can become sick, but that's rare. So if you are concerned about such events, come sit down and talk with me. We will decide." Because again, understand that public health is not a single person's perspective. It's a population perspective. But when you have to make your decision for yourself, it is your decision and your perspective. So you have to mesh the two together to sort of have a uniform policy. Probably past three years, you've seen these two, the individual perspective versus the public health perspective. And it's a healthy conversation to have had. So you have to just decide how much of it is yours and how much of it do you owe to the community.

Chrissy Billau:
Okay. Now let's talk about some aspects of your practice. What have you been working on lately?

Dr. Deepa Mukundan:
Well, lately, a lot of infections, different infections, not COVID, in the hospital, which has been very challenging. Patients have come pretty sick. And that's a little worrisome, but these come and go. It's like a rollercoaster. There are times when the number of patients you see and the number of problems you see are much more than you can handle. And there are times when things calm down. So at this point I would say we are seeing good number of infections, especially in people who are at high risk, who are immune compromised and all that. But I don't see any reason for alarm. It's just taking a lot out of me. That's it.

Chrissy Billau:
Well, what is one thing you'd like to tell your patients relevant to your specialty or just in general? If you could tell everybody one thing for their health, for their wellbeing, what would it be?

Dr. Deepa Mukundan:
I would say don't panic and moderation is a good idea. Get all the facts. And then think about it and have a calm and moderate approach to everything. Nothing is a hundred percent in life.

Chrissy Billau:
I like how you talked about respect and trust in conversations, especially when it comes to whether you get a vaccine. And I think it's great how you talk with them like that. Well, thank you, Dr. Mukundan. That is all for this episode of Prescribed Listening from the University of Toledo Medical Center. Subscribe to hear more on your favorite podcast platform. And join us next week for another episode where we tackle more of the top Googled health questions.