(film reel clattering) - Welcome to all of us.

Thank you for joining us.

Just as the omicron wave was surging, we began to notice news reports of a new virus called monkeypox.

If COVID has taught us anything as journalists, it's that we have to take any news associated with the word "virus", seriously.

And, how intriguing to have a virus called monkeypox.

No one has died of monkeypox, according to the Centers for Disease Control.

But, how worried should we be?

Because of the valuable pool of medical experts we've acquired over the last two years of covering the pandemic, we decided to ask two of these speakers to help us and join us on today's briefing, so that we could better inform our audiences and gain new insight into what a virus is, and how it spreads.

We welcome back Dr. William Shaffner, at Vanderbilt University School of Medicine.

And, Dr. Ben Neuman, at the Global Health Research Complex, at Texas A & M University.

So now, I turn the moderation over to my colleague, Sunita Sohrabji.

Sunita?

- Sandy, thank you very much.

And, thank you to all our speakers and reporters.

We start with Dr. William Shaffner, who will give us an overview of monkeypox, its prevalence in the U.S., symptoms, therapeutics, possible vaccines.

Dr. Shaffner, welcome back.

- Thank you, Sunita, and thank you, Sandy.

It's good to be with you, of course.

And, I expect that my remarks will overlap those of my colleagues, substantially.

But, there are things that are worth saying repeatedly, and we will inform each other.

Monkeypox is a virus that circulates in Central and West Africa.

It's a member of the larger family, which includes that virus which we have eradicated already from the face of the earth, smallpox.

But clinically, in its classic form, it resembles smallpox in some ways.

In West Africa, particularly in Nigeria, its reservoir, that is the place where this virus normally lives, is in the animal populations, probably small animals.

We're not entirely sure which ones.

The virus is called "monkeypox", because it was first identified in that primate species, which goes to the point that it can also obviously infect humans.

There are two major strains of this virus, the Central African strain, which is more severe.

The West African strain- which is fortunately involved here- which produces milder, generally, infections.

Now, at the moment, in the United States, as of two days ago, on the 22nd, I have from the CDC, that there were already 155 cases.

They're involving 24 states, and the District of Columbia.

The states most frequently affected were California, New York, Florida and Illinois.

Now, the cases range in age from 20 to 76, with an average of 37.

No children have been involved.

98% of the cases have occurred in men.

And, that's a striking epidemiologic feature.

Because it is thought that this virus was spread initially in Gay Pride events, among gay and bisexual men, that occurred in Europe, particularly the Canary Islands, Berlin, and perhaps also in France.

Where, this virus was transmitted among the enthusiastic participants, who then went home, and then have initiated smaller outbreaks, and chains of transmission in their home countries.

Here in the United States-- well, I should say first.

In May 22nd in the U.K., there were three clusters that were defined.

One was travel associated.

Then there was a "family" cluster of three.

That family hadn't traveled, and it is not clear how that family became infected.

And then, there were several patients who were identified in sexual health clinics.

The first case in the United States was diagnosed on May 17 in Massachusetts.

This is a person who had been in Canada, and perhaps acquired their infection there.

They presented with a rash on their backsides, in their anal genital region, which subsequent spread to their face and to their trunk.

Now, this is a virus which is spread through close personal contact, usually skin-to-skin contact among humans.

It can be spread via the respiratory route by what we call "droplet transmission."

In other words, very close, within three feet, usually over a prolonged period of time.

Skin-to-skin, very close respiratory, and the third way on occasion, through contaminated towels, and perhaps bedding.

So, that can happen also.

Please note that this is not, this is not a virus that spreads widely and readily the way COVID does.

It usually spreads through chains of transmission, person-to-person, as a consequence of this close personal contact.

Let me tell you a little bit about the clinical presentation.

And, I'm going to say that this virus is doing what viruses sometimes do.

They deviate from the description in the textbook!

And, I'll try to make some of those distinctions.

So, after you contact the virus, it can take a period of time, a week, up to two weeks of an "incubation period."

You feel perfectly fine.

Then you may get an initial "virus-like illness": headache, not feeling so well, perhaps some fever, perhaps some swollen lymph glands.

That can last a day or two.

And then, a rash develops.

Now classically, this is a rash like smallpox, classically, that occurs dominantly in the arms and on the hands, the face and head, and the legs and the feet.

But, this virus is doing something different.

It often has very few lesions and they may occur only in the genital area, or on your backside, in and around on your buttocks, and your anus.

Also classically, all of the lesions are in the same phase.

This virus?

Not so.

(dry chuckle) The lesions may be in different phases simultaneously!

That also leads to some diagnostic confusion.

The rash appears and makes a blister.

It's usually a clear blister, then over time becomes filled with pus.

One of the distinctive features of this rash is that if you feel the blister, it's firm and rubbery.

It is what we call, quote, quote, "deep-seated."

It does not break readily.

Unlike the very thin blisters of chickenpox, for example.

These lesions will slowly get better over time.

They may develop a little umbilicated center.

That is, the blister has a little crater in the center of it as it evolves and scabs, and goes away.

The fluid in the blisters, and the skin around it are very contagious, and that direct skin-to-skin contact is how this virus is transmitted.

We've had no deaths in the United States.

In that, we are very fortunate.

We will talk about the public health responses.

We will mention vaccines in our discussion.

I'll leave some of that to my colleague.

And, there are also some therapies that are potentially available.

Most people have a rather mild infection.

Treated as outpatients with symptomatic treatment, and it resolves by itself.

So, that's very fortunate.

I think I'll stop there.

And then, we can enjoy a discussion amongst ourselves, and with the reporters.

And, Sarah asked, is this useful to call it an STD?

- We don't like to call it an STD, because it does not involve the reproductive organs themselves.

Now studies are underway to see this-- whether this virus can be transmitted in semen.

In which case, it would become more classically designated an STD.

But, those studies are still underway.

- Interesting.

And, what should people be on the lookout for in terms of understanding whether they, themselves, have monkeypox?

- Well, as you can see at the moment, this viral infection is rather confined, not completely, but rather confined to a distinctive population group among men who have sex with men, or men who are bisexual.

And, that group of people should be very aware and be careful about their current sexual practices.

And, to avoid anonymous sex, and to be very personally clean, and inspect themselves, and inspect their partners to see whether they have lesions.

I think those are very, very important things.

And, we could talk a little bit more about other details of things one might do.

If you're using sexual toys, to make sure that they're appropriately cleaned and disinfected.

But, taking personal care about your partner, knowing your partner, having confidence in your partner, I think becomes very, very important at this time.

I will say that in some communities, New York City, for example- and here we're getting into vaccines- they're starting to use one of the two vaccines that we have available.

And, my understanding is that the very first day they made this vaccine available, there were many gentlemen who came forward and wished to take advantage of the vaccine.

- What vaccine?

I'm sorry.

Could you clarify?

- Alright.

There are two vaccines.

Both originally designed to prevent smallpox, but they also prevent monkeypox.

One of them is like the old smallpox vaccine.

That is a live attenuated virus, a tamed virus.

It's inoculated through a multiple pressure system- the way we used to give smallpox vaccine- on the surface of the skin.

It has fewer side effects than the old smallpox vaccine.

But, because it's a live virus on the skin, it can be transmitted to others, or, you can transmit it to other parts of your own body, and that can lead to complications.

The other vaccine, is a vaccine which doesn't multiply, and is administered by the conventional needle and syringe.

That's called the JYNNEOS vaccine.

It takes two doses separated by a month.

And, because it's administered by needle and syringe, and the virus there cannot multiply, it's considered the safer vaccine.

It is available, and it is licensed by the Food and Drug Administration for use in monkeypox prevention.

The United States government has a supply of it, some of which has now been distributed to some locations in the country.

And, as I said, some of them are starting to make the vaccine available to gay and bisexual men.

- Thank you so much, Dr. Shaffner.

We will reserve time at the end of the briefing for more questions for you.

But, we move on to Dr. Ben Neuman.

Dr. Neuman, how did it get here?

How did we get this virus from Central and West Africa?

If we could start with that, that would be terrific.

- Sure.

Dr. Shaffner gave a great overview of the early steps of this, I think!

I believe the earliest case which is traced in this particular outbreak was of a British person who contracted it in Nigeria, and then came back to the U.K. And then, within a week or two, the normal incubation time, there was a small cluster there.

There have been no reports on whether people in that cluster went to some of these large gatherings which were associated with further onward transmission.

But, there would be pretty strong stigma against people, particularly if in some countries, so I can understand the need for privacy there.

If you mean in the larger sense, "how did we get here?"

This is one of many, what we would call "neglected and tropical" diseases.

Things which are very damaging, potentially scary, but generally do not infect many people.

We live in a world with far more viruses than people who can study them.

And so, the effort tends to go where the money and the interest goes.

And, not every virus gets its due until something like this happens.

- Please continue on with your presentation.

- Oh, sure.

So, monkeypox has only been reported in a small number of people, but among those, four were pregnant people.

They were collected together in one paper.

In those four patients, two of the babies died very early during pregnancy.

One baby was born and appeared to be normal; everything was fine.

The fourth baby was not born.

It was stillborn, and it was covered with monkeypox, human monkeypox-like lesions all over it.

This is very typical for orthopoxviruses.

That is the group of viruses that includes mousepox, and camelpox, and cowpox, and this virus.

Those viruses grow very well in the placenta of a lot of animals.

And, in an infected animal, an experimental animal, you will see the highest doses of the virus in the placenta, and also high doses in the uterus.

In similar cases with other viruses, so things like Lassa fever virus.

When the mother is infected, and the virus is transmitted to the fetus, the mother has a much higher chance of survival if there is an emergency abortion.

At least in animal studies, mice that are infected with viruses like this, seldom if ever survive all the way to term, whenever the fetus is due.

So, controlling access to who would be able to, and when they would be able to have these sorts of potentially life-saving medical services is now a concern, if this virus were to spread.

There's nothing about this virus that means that it has to spread among men who have sex with men.

It is a virus that would've spread just as easily inside a crowded dance club, or at a concert, or any other venue where you have lots of people together, and they're having a good time.

So, it's a thing to be watched.

It's not something that is immediately scary right now, I would say.

But, this is something that could get out-of-hand, and very much something that should be stopped before it gets out-of-hand, in my opinion as a virologist.

- So, Dr. Neuman, how does it get out-of-hand?

What are the conditions that will allow it to get out-of-hand?

And, can you compare this to COVID, which we've just gone through?

Are there similar environmental factors that are going to allow this to spread as rapidly as COVID did?

- So, in an infected experimental animal, you find high doses of the virus in the liver, where no one is going to come in contact with your liver.

That's okay.

You would find high doses on the skin, and you would find high doses in the nasal passages.

Now, it's the nasal passages that worry me.

Because those would allow us to spread the virus a little bit further, a little bit faster.

It is very tempting to compare this to the spread and the changes that happened to COVID during that spread.

We don't know if there are other possible mutations that could make the virus a little more stable, or a little more efficient at coming out of cells, or a little more effective at entering cells along the nasal passages.

But, any changes in that direction would be predicted to make this more transmissible, and potentially transmissible to a wider number of people.

Now, this has not happened yet.

This is only a scientific "what-if."

So, we should not be alarmed that it has changed.

The virus that we see now is, I believe only about 40 mutations different from the virus that appeared in Nigeria about four years ago.

So, it changes slowly, which is typical for a DNA virus.

But, each time a virus emerges from the wild into people, there are some changes, and some unknowns.

And, potentially some surprises.

Hence, as a very conservative virologist, I do not like surprises when it comes to viruses!

Yeah.

- Thank you.

Araceli Martinez from "La Opinión" has a question for you, Dr. Neuman.

- Araceli, please ask your question.

- Thank you, Sunita.

Good morning.

I was wondering if there are certain, any groups with a higher rate of contracting the disease?

And, how can we protect in our daily lives?

Thank you so much.

- This is a good question.

In a few years, we may be able to give you a satisfactory answer!

For right now, the virus seems to work equally well in a person, and a guinea pig, and a hamster, and a prairie dog, and an African pouched rat.

So, I don't think we can expect any major differences between people who look slightly different to us.

I think we probably all look roughly the same to the virus!

- Dr. Neuman, how prevalent is monkeypox in Central and West Africa?

And, can you compare that to what's happening here in the U.S.?

- So, as Dr. Shaffner said, there are two major clusters of the virus.

And, the one that is normally found in Central Africa is actually the more dangerous of the two.

It causes more fatalities, we think.

It's also the one of the two that grows generally in places with less access to testing and fewer hospitals that can actually confirm it.

So, the numbers are almost certainly under-reported.

This is the milder West African strain.

But, there have been over a thousand cases of the more severe strain this year already in Central Africa.

And, right now, the only thing that is keeping that virus from getting out to the rest of the world, is the relative geographic and economic isolation of the area.

And, I do not believe we can count on that as an effective stopgap in the future.

- Absolutely.

Dr. Neuman, thank you so much for your insights.

Dr. Shaffner, is there anything you wanted to add to Dr. Neuman's response on how this virus looks in West and Central Africa versus the U.S.?

- Well, this is just a minor little addendum to Ben's beautiful presentation.

Once we conquered smallpox, we just basically began to appreciate monkeypox.

And, initially, we thought it was just a very rare occasional infection that occurred when local people came in contact with some small mammal (ahem) and it was introduced to them.

But, things have been changing in Africa over the last several years.

And, for reasons not well understood, particularly in Nigeria, there has been an increase of cases of monkeypox.

And, as Dr. Neuman said, some of those cases have been fatal.

The reason for this increase in Nigeria, in particular, I think remains still unexamined.

And, we don't know the reason.

But, the more there is in West Africa, the more likely it is, there will be transmission, as there has just been to other parts of the world, because of travelers going in both directions.

Nigerians going elsewhere, and people from other countries going to Nigeria.

And, both can bring the virus to other parts of the world.

- And, how possible is it that you can get re-infected with monkeypox?

Now I understand that it's just the start of this conversation on monkeypox.

We don't probably don't have data on re-infection, but is there a possibility of re-infection?

- Anything's possible... - Anything!

(Sunita laughs) - until proven otherwise!

Especially, with viruses.

With smallpox virus, it tended to be one infection per person at most.

And so, until we understand monkeypox better, that's probably the most likely assumption.

But, never take a virus' word for anything!

Yeah.

(chuckles) - Sandy?

- Thank you so much on this effort to learn about COVID, and now monkeypox.

Thank you so much.

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