‏إظهار الرسائل ذات التسميات Disease_outbreaks. إظهار كافة الرسائل
‏إظهار الرسائل ذات التسميات Disease_outbreaks. إظهار كافة الرسائل

scientists worry virus could infect animals

Monkeypox virus, illustration. Thom Leach | Science Photo Library | Getty Images

In 2003, 47 people across six Midwestern states caught monkeypox from pet prairie dogs that were infected after they were housed with rodents imported from Ghana, Africa. Today's outbreak, which has already infected more than 14,100 people in the U.S. and more than 41,000 across the globe, is spreading mostly through close human contact among gay and bisexual men. But scientists reported the first presumed human-to-pet transmission in a dog in France this month, prompting U.S. and global health officials to step up warnings to ensure the virus doesn't spread to other pets and animals.  The recommendation stems from concerns that monkeypox could spill into wildlife or rodent populations as the human outbreak grows, allowing the virus to pass back-and-forth between humans and animals and giving the virus a permanent foothold in countries where it hasn't historically circulated.  Prior to the global outbreak this year, monkeypox spread primarily in remote parts of West and Central Africa where people caught the virus after exposure to infected animals. The 2003 outbreak, which was contained, was the first documented case of humans catching the virus outside Africa.

The current global outbreak differs dramatically from past patterns of transmission. Monkeypox is now spreading almost entirely through close physical contact between people in major urban areas in the U.S., European nations and Brazil.  But the first presumed case of people infecting an animal in the current outbreak was reported in France this month. A pet dog tested positive for the virus after a couple in Paris fell ill with monkeypox and shared their bed with the animal. 

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WHO officials have said a single incident of a pet catching the virus is not surprising or a cause for major concern, but there is a risk that monkeypox could start circulating in animals if people don't know they can infect other species.  If monkeypox becomes established in animal populations outside Africa, the virus would have more opportunities to mutate, which carries the risk of higher transmissibility and severity. Animals could then potentially give the virus to people, increasing the risk of future outbreaks. "What we don't want to see happen is disease moving from one species to the next and then remaining in that species," said Dr. Mike Ryan, director of the WHO's health emergencies program, said during a press conference in Geneva last week. "It's through that process of one animal affecting the next and the next and the next that you see rapid evolution of the virus." The Centers for Disease Control and Prevention has not received any reports of pets infected with monkeypox in the U.S., said Kristen Nordlund, an agency spokesperson. But the virus can spread from people to animals or from animals to people, according to the CDC.  "While we are still learning which species of animals can get monkeypox, we should assume any mammal can be infected with monkeypox virus," Nordlund said. "We do not know if reptiles, amphibians, or birds can get monkeypox, but it is unlikely since these animals have not been found to be infected with viruses in the same family as monkeypox." Dr. Rosamund Lewis, the WHO's lead monkeypox expert, said it's important to dispose of potentially contaminated waste properly to avoid the risk of rodents and other animals becoming infected when they rummage through garbage. "While these have been hypothetical risks all along, we believe that they are important enough that people should have information on how to protect their pets, as well as how to manage their waste, so that animals in general are not exposed to the monkeypox virus," Lewis said. Ryan said that while vigilance is important, animals and pets do not represent a risk to people at the current time. "It's important that we don't allow these viruses to establish themselves in other animal populations," Ryan said. "Single exposures or single infections in particular animals is not unexpected."

Rodents in Africa

Although scientists have done some research on monkeypox in Africa, where it's historically circulated, their work was limited due to a lack of funding. So scientists don't know how many different species of animals can carry the virus and transmit it to humans. Scientists have only isolated monkeypox from wild animals a handful of times in Africa over the past 40 years. They included rope squirrels, target rats and giant pouched rats in the Democratic Republic of Congo, as well as two types of monkeys in Cote d'Ivoire. Rodents, not monkeys, are thought to be the host animal population in Africa, though the precise animal reservoir is unknown. Public health officials don't know whether the types of animals in close proximity to people in urban settings in the U.S. -- racoons, mice and rats -- can pick up and transmit the virus. Some types of mice and rats can get monkeypox but not all species are susceptible, according to the CDC. "We know this is a virus that's transmitted from rodents in West Africa," said Dr. Peter Hotez, an infectious disease expert at Baylor College of Medicine in Texas. "Could rats or other rodents in urban environments mean that it gains a foothold there and it also becomes more of a permanent fixture — we don't want that to happen," he said. The CDC recommends that people who have monkeypox avoid contact with animals — pets, livestock, domestic animas and wildlife. If a pet becomes sick within 21 days of contact with someone who has monkeypox, the animal should be evaluated by a veterinarian. Waste contaminated with monkeypox should go into in a lined, dedicated trash can and shouldn't be left outside because wildlife could potentially become exposed the virus, according to CDC.

U.S. outbreak in 2003

In the 2003 outbreak, the CDC was able to quickly administer vaccines and quarantine patients before the virus could spread farther. There were no cases of monkeypox spreading between people. The CDC then banned the importation of rodents from Africa. Containing the 2003 outbreak took 10,000 hours of work to trace the virus back to Gambian rats and other rodents imported from Ghana to an animal distributor in Texas, according to Marguerite Pappaioanou, a former CDC official who worked on the outbreak. The Food and Drug Administration banned the importation of all African rodents in the wake of the 2003 outbreak. The agency also prohibited the interstate distribution of prairie dogs and their release into the wild over concerns monkeypox could become established in wildlife populations. The U.S. Georgical Survey and Department of Agriculture subsequently trapped 200 wild animals in Wisconsin at sites close to where humans contracted monkeypox from pet prairie dogs. They did not find any evidence that the virus had spread into wild animals, and the FDA lifted the ban on distributing prairie dogs between states. It's still illegal to import rodents from Africa.

Wastewater worries

Scientists in California detected monkeypox DNA in sewage samples this summer. New York is also conducting wastewater surveillance for the virus, according to the state health department, though results have not been publicly released yet. The wastewater findings in California have raised concern among some health experts that the virus could infect rodents through the sewage. "There is the risk because of the widespread nature of infections and the fact that it's sewage and wastewater," said Dr. James Lawler, an infectious disease expert at Global Center for Health Security at the University of Nebraska Medical Center. "That's a concern, about getting into an animal population and having a zoonotic risk reservoir and honestly, if that's the case that I think it's game over for us." But it's not clear if live virus is present in wastewater. The study measured monkeypox DNA in sewage samples, not whether the virus was still infectious, according to Marlene Wolfe, a scientist at Emory University who is working on the project. Wastewater is treated in most urban areas so the probability of the virus surviving and replicating in such an environment is low, according to Amira Roess, a former official with the CDC's Epidemiological Intelligence Service. Roess said garbage that contains contaminated materials such as bedsheets or towels likely poses a higher risk than wastewater. "There are wildlife species that rummage in your garbage and then they're more likely to pick up virus that is able to replicate. "There's a lot of ifs, but it happens," said Roess, who is now a professor of epidemiology at George Mason University.

Low probability

Better surveillance needed


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CDC admits Covid response fell short, launches reorganization

CDC Director Rochelle Walensky is reorganizing the agency, saying it didn't react quickly enough during the Covid pandemic, according an internal review of the agency's operations released on Wednesday.

Walensky laid out several organizational changes the Centers for Disease Control and Prevention will take over the coming months to correct missteps and failures that occurred during the last 2.5 years of the pandemic, according to a fact sheet.

"For 75 years, CDC and public health have been preparing for COVID-19, and in our big moment, our performance did not reliably meet expectations," Walensky said in a statement.  "My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness."

The central objectives of the reorganization are focused on sharing scientific data faster and making it easier for the public to understand health guidance, according to the briefing document. Walensky launched the review in April after the massive winter surge of infections from the omicron variant upended the nation's public health response.

The CDC repeatedly faced criticism during the pandemic for confusing public health recommendations and releasing data too slowly through retrospective reports that were outpaced by the rapid spread of the virus. Public health experts were often frustrated that briefings on the pandemic relied on data from other countries, such as the United Kingdom and Israel.

Walensky is appointing an executive to lead a team that will implement changes. The CDC will also create a new executive council that reports directly to Walensky to determine the agency's key priorities backed up by budget decisions.

The agency's science and laboratory sciences divisions, which play crucial roles in investigating and tracking public health threats such as Covid, will also report to the CDC director.

The CDC is also creating an equity office to make sure agency's workforce reflects the U.S. population and better communicates public health guidance across all groups.

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California appeals court rejects COVID-19 fines for church

SAN J0SE, Calif. -- A California church that defied safety regulations during the COVID-19 pandemic by holding large religious services won't have to pay about $200,000 in fines, a state appeals court ruled.

Calvary Chapel San Jose and its pastors were held in contempt of court and fined in 2020 and 2021 for violating state and county limits on indoor public gatherings. The rules were aimed at preventing the spread through close contract of the virus, which has caused more than 10 million confirmed cases and more than 93,500 deaths since the pandemic began in mid-2020, according to state public health figures.

But on Monday, California's 6th District Court of Appeal reversed those lower court decisions, citing a May 2020 ruling by the U.S. Supreme Court in February 2021 that a ban by Gov. Gavin Newsom on indoor worship services in counties where COVID-19 was surging violated freedom of religion.

The decision by a newly conservative majority court came less than a year after the high court previously ruled the ban was justified on health and safety grounds.

The appellate court noted that the restrictions on indoor gatherings also applied to secular gatherings but were stricter for worship services than for secular activities such as going to grocery stores.

The ruling “is a great win for the sake of liberty and displays the justification for the courage shown by this church" and its pastors, Robert Tyler, a lawyer for the church, told the San Francisco Chronicle.

Despite the ruling, Santa Clara County said it will continue to seek $2.3 million in penalties against the church for violating other COVID-19 rules that weren't affected by the decision, such as requiring face masks during services in late 2020.

“Calvary did not dispute the fact of its numerous and serious violations during the height of the pandemic and before vaccinations were available," a county statement said. “We will continue to hold Calvary accountable for putting our community’s health and safety at risk.”


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CDC eases guidance as U.S. has more tools to fight the virus

The Centers for Disease Control and Prevention eased its Covid-19 guidance on Thursday, saying the virus now poses a much lower risk of severe illness, hospitalization and death compared to earlier in the pandemic.

The CDC no longer recommends testing people in schools who don't have Covid symptoms, its previous strategy to catch possible infections and head off outbreaks. But such screening is still recommended in certain high risk settings such as nursing homes, prisons and homeless shelters.

And people who aren't vaccinated no longer need to quarantine if they have been exposed to Covid, according to the new CDC guidance. Instead, public health officials now recommend that these individuals wear a mask for 10 days and get tested on day five.

A sign outside of a hospital advertises COVID-19 testing on November 19, 2021 in New York City. On Friday vaccine advisers to the US Centers for Disease Control (CDC) and Prevention voted unanimously in recommending a booster shot of the COVID-19 vaccines for all adults in the United States six months after they finish their first two doses.

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The CDC, in a report published Thursday, said there is a high level of immunity in the population from both the vaccines and infections which means the virus now poses a much lower threat to public health. Greta Massetti, a CDC epidemiologist, said the U.S. has the vaccines and treatments needed to fight the virus. But it remains crucial for everyone to remain up to date on their vaccines, according to the public health agency.

"This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives," Massetti said in a statement.

The changes in CDC guidance come as public health officials have warned that the U.S. could face a major wave of infection in the fall and winter, as immunity from the vaccines wanes off and people gather indoors to escape the colder weather.

The U.S. has repeatedly faced new omicron subvariants that are more transmissible than previous versions of the virus, which has led to stubbornly high levels of infection. The dominant version of the virus right now is omicron BA.5, which caused infections to increase during the spring and early summer.

What to do if you test positive

People with healthy immune systems, regardless of vaccination status, should isolate for five days after testing positive for the virus, but you can end isolation at day six if you have not had symptoms or if you have not had a fever for 24 hours and other symptoms have improved, according to the guidelines.

After leaving isolation, you should wear a high-quality mask through day 10 after your positive test. If you have had two negative rapid antigen tests you can stop wearing your mask earlier, according to the guidelines. But you should avoid people who are more likely to get sick from Covid, such as the elderly and people with weak immune systems, until at least day 11.

People with weakened immune systems, those who have been hospitalized with Covid, or those who have had shortness of breath due to the virus should isolate from others for 10 days. But people with weakened immune systems and those who were hospitalized should also consult a physician before ending isolation.

If you end isolation but your Covid symptoms worsen, you should return to isolation and follow the guidelines from scratch again, according to the CDC.

The U.S. is currently reporting more than 107,000 new Covid cases a day on average, according to the CDC. That's likely a significant undercount because many people are now testing at home and results are not picked up in official data.

About 6,000 people with Covid are admitted to the hospital a day on average, according to the CDC data. Nearly 400 people are still dying a day on average from the virus.

About 67% of people in the U.S. are fully vaccinated, according to the CDC. But only 48% of those who received their first two shots got their recommended booster dose. And just 30% of children ages 5 to 11 are fully vaccinated, according to the data.


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Biden to sign executive order to help cover costs for women traveling for abortions

US President Joe Biden appears on a monitor as he speaks on reproductive care services, during the first meeting of the interagency Task Force on Reproductive Healthcare Access in the Indian Treaty Room of the Eisenhower Executive Office Building, next to the White House, in Washington, DC, on August 3, 2022.

Mandel Ngan | AFP | Getty Images

U.S. President Joe Biden signed an executive order on Wednesday to help cover costs for women traveling to receive abortions.

Biden directed Health and Human Services Secretary Xavier Becerra to encourage states to write rules so their state Medicaid plans could cover certain costs for women traveling to receive abortions in states where the procedure remains legal.

"This executive order also helps women travel out of state for medical care," Biden said during a the first meeting of the White House task force on reproductive health-care access. "Secretary Becerra is going to work with states through the Medicaid to allow them to provide reproductive health-care for women who live in states where were abortions were are being banned in that state."

The president's executive order also directs Becerra to ensure health-care providers do not discriminate against women on the basis of pregnancy. HHS will collect more data on the impact that abortion bans have on maternal health.

But groups such as Planned Parenthood have called on the Biden administration to use all the emergency powers at its disposal to protect access to abortion. The Center for Reproductive Rights has specifically called on HHS to use an emergency health law, called the PREP Act, to enable health-care providers in states where abortion remains legal to prescribe and dispense mifepristone for early abortions for women in states with bans.

The Biden administration has considered declaring a public health emergency to protect access to the abortion pill, but it worries physicians could potentially face prosecution in states that have banned the procedure, a senior administration official said.

The White House hasn't used those powers yet because officials worry that it might not be enough to protect physicians and women in the end, the senior administration official said.

The law gives the Health and Human Services secretary the authority to extend legal protections to anyone who manufactures or administers a drug that's needed to respond to a public health emergency. It was widely used in March 2020 to protect Covid-19 vaccine makers, test manufacturers and pharmaceutical companies like Pfizer that were making therapeutic drugs like the antiviral Paxlovid. It also protected physicians administering the shots and tests.

Under that authority, HHS Secretary Becerra could designate the abortion pill, mifepristone, as a drug needed to prevent a health emergency caused by reduced abortion access. This would, in theory, preempt state abortion bans and make mifepristone available to women in those states, opening an avenue to early pregnancy abortions.

"One of the concerns we have about invoking the PREP Act is that we're concerned that we might not be able to protect women and doctors from liability, including criminalization. So that's why we haven't yet taken that action," the senior administration told reporters on a call.

Legal experts have said Republican state officials would immediately sue the administration for using the PREP Act to protect medication abortion and a federal court could quickly block the action from taking effect. The issue could ultimately end up before the same conservative-controlled Supreme Court that overturned Roe v. Wade.

Biden said Wednesday voters need to elect more members of Congress in the upcoming midterms who will support codifying Roe v. Wade through federal legislation. He pointed to Kansas voters resounding rejection Tuesday night of a ballot initiative that would have repealed the state's constitutional protections for abortion.

"Voters of Kansas sent a powerful signal that this fall the American people will vote to preserve and protect the right, and refuse to let them be ripped away by politicians," Biden said.

Many states that have banned abortion in the wake of the Supreme Court's decision to overturn Roe. v. Wade have also barred physicians from administering drugs to terminate pregnancies, which would include mifepristone. The state bans in most cases make performing an abortion a felony that can carry yearslong prison sentences.

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Women who receive abortions are generally exempt from prosecution under most of the state bans, but reproductive rights activists are worried that Republican state officials will ultimately try to prosecute patients who receive the procedure as well.

The Food and Drug Administration approved mifepristone more than 20 years ago as a safe and effective way to end a pregnancy before the 10th week. Mifepristone is taken in conjunction with misoprostol to induce contractions that end early pregnancies.

Medication abortions have become an increasingly common procedure to end pregnancies in the U.S. Mifepristone used in conjunction with misoprostol accounted for more than 50% of abortions in the U.S. in 2020, according to a survey of all known providers by the Guttmacher Institute.

In December, the FDA decided to permanently lift a requirement that women obtain the pill in person, making it easier to dispense the pill by mail through telemedicine appointments.

But the physical location of the patient determines which state's telemedicine laws apply. This means women in states where abortion has been banned cannot receive the procedure through telemedicine with providers in states where it is legal.


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Micronesia's first COVID-19 outbreak balloons, causing alarm

WELLINGTON, New Zealand -- Micronesia's first outbreak of COVID-19 grew in one week to more than 1,000 cases by Tuesday, causing alarm in the Pacific island nation.

Last week, Micronesia likely became the final nation in the world with a population of more than 100,000 to experience an outbreak of the disease, after avoiding it for 2 1/2 years thanks to its geographic isolation and border controls.

Health officials said cases were rapidly increasing. It reported 140 new cases Monday, bringing the total to 1,261, a figure which includes some cases caught at the border before the outbreak.

Eight people have been hospitalized and one older man has died, officials said.

Many top lawmakers and senior officials have caught the disease, including Vice President Yosiwo George, who has been hospitalized, officials said. They said the vice president's condition was improving.

Camille Movick, whose family owns Fusion Restaurant in Pohnpei State, told The Associated Press that a lot of people have been posting on Facebook asking, for instance, that others stay away from their homes.

“Initially there was quite a bit of panic and worry with most people,” she said.

She said her restaurant remained open although business was slow because many people were afraid to dine in. She said some other restaurants had closed their dining rooms and were only offering takeaway services.

Movick said authorities had issued a directive that all people must wear masks in public — even outdoors — and that they faced fines of $1,000 for noncompliance.

She said one positive outcome was the outbreak had prompted many previously unvaccinated people to get their shots.

She said many people suspected the virus might have been circulating before the first community case was confirmed last week because health authorities weren't routinely testing patients for the disease.

Last year, Micronesia became one of the few countries to impose a broad mandate requiring all eligible citizens get vaccinated against the coronavirus.

The government threatened to withhold federal funds from any individuals or business owners who didn’t follow the rules. Health officials said this week that 75% of people aged 5 and over were fully vaccinated.

Movick said many parts of society were continuing to function as before, including many people who were working from their offices.

"We're hoping things get back to normal soon,” Movick said. “Just like in other countries, over time, they’ve gotten over it, and lifted the restrictions.”


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Biden administration considering public health emergency

The Biden administration is considering declaring a public health emergency in response to the growing monkeypox outbreak, a senior White House health official said on Friday.

Dr. Ashish Jha, the White House Covid response coordinator, said the administration is looking at how a public health emergency declaration might bolster the U.S. response to the outbreak.

"There's no final decision on this that I'm aware of," Jha said. "It's an ongoing, but a very active conversation at HHS."

Health and Human Services Secretary Xavier Becerra has the authority to declare a public health emergency under the Public Health Services Act. A declaration can help mobilize federal financial assistance to respond to a disease outbreak.

The U.S. has reported more than 2,500 monkeypox cases so far across 44 states, Washington, D.C., and Puerto Rico, according to the Centers for Disease Control and Prevention. The largest outbreaks are in New York, California, Illinois, Florida, D.C. and Georgia.

The Biden administration's response to the outbreak has come under scrutiny from Congress as infections rise. Fifty House Democrats, in a letter to President Joe Biden this week, called for the administration to declare a public health emergency in response to the outbreak.

Senate Health Committee Chair Patty Murray, in a letter to HHS Secretary Becerra, said she is worried about the U.S. response to the outbreak. Murray said some patients and health-care providers do not have the information and resources they need to test for monkeypox and respond to the outbreak.

CDC Director Rochelle Walensky said last week that demand for the vaccines is outstripping the available supply. Many people are struggling to get vaccinated amid long lines outside clinics.

The U.S. has shipped more than 300,000 doses of the monkeypox vaccine, called Jynneos, to city and state health departments so far, Jha told reporters Friday. The Food and Drug Administration is in the process of authorizing an additional 786,000 doses stored at the manufacturer Bavarian Nordic's facility in Denmark for distribution in the U.S.

Jha said some of those shots have started shipping and will arrive in the U.S. this week and next week. The doses can be delivered to city and state health departments once FDA authorization is complete, Jha said. The U.S. has also ordered another 5 million doses that will be delivered through the middle of 2023, according to HHS.

Monkeypox is primarily spreading through skin-to-skin contact during sex. Right now, men who have sex with men are at the highest risk of infection, but anyone can catch the virus through close physical contact. People generally recover in two to four weeks, but the virus causes lesions that can be very painful. No deaths have been reported in the U.S.

The CDC on Friday confirmed the first two cases of monkeypox in children. One case is a toddler in California, and the other is an infant who is not a U.S. resident. The cases are not related and the children likely caught the virus due to transmission within their household, according to CDC.

The children are both in good health and are receiving the antiviral treatment tecovirimat, according to the CDC. Dr. Jennifer McQuiston, a CDC official, told reporters Friday that the health agency is working to make it easier for clinicians to prescribe tecovirimat to patients.

Prescribing tecovirimat for monkeypox comes with an additional layer of bureaucracy right now because it is only FDA approved for smallpox. Monkeypox is in the same virus family as smallpox, but it causes milder disease.

McQuiston said more than 97% of patients with monkeypox who provide demographic information are gay, bisexual or other men who have sex with men.

"While this outbreak is spreading in a particular social network right now, I think we've messaged from the start that there could be cases that occur outside those networks and that we need to be vigilant for it and ready to respond and message about it," McQuiston told reporters.

The U.S. has the capacity to conduct 80,000 monkeypox tests a week after bringing on several commercial labs this month, according to the CDC. But the tests swab the lesions that caused by the virus, which can take weeks from the initial exposure to develop. This means the U.S. likely does not have an accurate picture of how many people are infected because patients can only get tested once symptoms develop.


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