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How the U.S. struggled to respond rapidly to the monkeypox outbreak: Experts

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(NEW YORK) -- In early May, when the first cases of monkeypox surfaced in the United Kingdom and Europe, health officials in the United States advised Americans not to panic.

There had been outbreaks of the rare disease before that had been controlled with testing and vaccines, and experts were optimistic an outbreak of monkeypox in the U.S. could be contained.

"We're working hard to contain the cases that are happening so they don't spread onward," Jennifer McQuiston, deputy director of the Centers for Disease Control and Prevention's High Consequence Pathogens and Pathology division, said during a media briefing in May.

More than two months later, the situation appears to be much different.

As of Friday, there were more than 7,100 reported cases in the U.S. across 48 states, the District of Columbia and Puerto Rico, according to the CDC, resulting in the Department of Health and Human Services declaring the outbreak a public health emergency Thursday.

That stands in stark contrast to instances of the disease in the recent past -- two travel-associated cases in 2021 and a small outbreak in 2003 linked to contact with pet prairie dogs, which were infected after being kept near small mammals from Ghana.

Currently, about 80,000 specimens per week are being tested and at least 600,000 vaccines have been distributed throughout the nation, health officials said during a media briefing Thursday.

While the federal government has acquired more than 1 million vaccine doses as part of the national stockpile preparedness program and has newly appointed monkeypox crisis coordinators, some public health experts interviewed by ABC News said the first cases in Europe back in May should have been a warning sign for the U.S. to ramp up testing and vaccination because of the possibility of community transmission.

Unlike COVID-19, monkeypox is more difficult to transmit, passing primarily through direct skin-to-skin contact. But there has been criticism leveled that it was a slow start and some mistakes made during the early days of the COVID-19 pandemic were repeated.

"Quite frankly, the inability of the government and inability of federal public health to respond sooner than it did is what cost us here," Dr. Perry Halkitis, dean of Rutgers School of Public Health, told ABC News.

The White House said Thursday President Joe Biden is getting "regularly briefed on monkeypox" and it's an issue that is "top of mind" for him.

Lack of alarm bells

The first case of the current outbreak was reported in the U.K. on May 7. Soon cases began to crop up in countries in mainland Europe, such as in Portugal and Spain.

The U.S. did not see a case of monkeypox confirmed until May 19 in a Massachusetts patient. With only one case, the Massachusetts Department of Public Health cautioned the risk to the public was low.

But like the early days of the COVID-19 outbreak, some public health experts warned that cases were likely more widespread than was publicly known.

Halkitis said the U.S. should have immediately started assembling a task force and increasing the supply of tests and vaccines after the first monkeypox patient was confirmed in Europe, suggesting potential community transmission.

"When the disease first appeared, that should have rung alarm bells for people," he said. "We know perfectly well from COVID how quickly things spread because of global travel. We should have been at that point acting immediately, putting task forces together, getting vaccines and we did not do that."

"Now they're going to put a task force together? It's a little late," Halkitis continued.

Testing criteria not broad enough

It was not until late June that the HHS announced it was expanding testing capacity and accessibility by shipping tests to five commercial laboratories nationwide.

Between mid-May and early June, U.S. laboratories had only tested a little more than 2,000 specimens from patients suspected to have monkeypox, a CDC report found.

However, testing has rapidly increased from 6,000 specimens per week in late June to more than 80,000 per week currently, CDC director Dr. Rochelle Walensky said during a media briefing Thursday.

"As testing has increased, our capacity for testing has increased and far outpaced the demand," she said. "So right now, we're really only testing at about 10% of the capacity we have, and we are encouraging anyone who has a prospective rash that could be monkeypox to present for testing."

The CDC currently recommends that people be tested only if they think they have monkeypox -- including the telltale sign of a rash -- or have had close contact with someone who has monkeypox.

But Dr. Peter Chin-Hong, an infectious diseases specialist at the University of California, San Francisco, said testing recommendations should be expanded to a few more groups because not all rashes look the same and some high-risk people may not know that they were even exposed.

"We should be testing much more than we're testing now and I think we should loosen the criterion or guidance for who we should test," he told ABC News. "I think we should flood the community with testing, just like in COVID."

He also said because monkeypox does not always manifest as a rash on the skin -- with sores sometimes appearing in the mouth, vagina or rectum -- those at high-risk who don't have a traditional rash should have swabs performed in those areas to test for monkeypox.

Delay in making vaccines available

In May, Biden called the level of exposure something "everybody should be concerned about" but that the country has vaccines and that it doesn't rise to the level of concern of COVID.

So far, the U.S. secured 6.9 million doses for delivery by May 2023, according to the HHS, with 1.1 million made available to states for ordering.

Some experts say vaccines could have been distributed a lot more quickly. The U.S. government currently has a contract with Danish firm Bavarian Nordic to "finish and fill" Jynneos, a vaccine approved for both smallpox and monkeypox.

The bulk of the 1.1 million doses initially sat in a plant that needed to be inspected by the U.S. Food and Drug Administration, a typical process for the agency.

Last month, the FDA said it had approved 786,000 doses to be released after it finished inspecting the plant and determined the vaccines being formulated there met its standards. The investigation only took about six weeks, much faster than typical for the FDA.

"Six weeks is pretty fast for that," Dr. Gregory Poland, head of the Mayo Clinic's Vaccine Research Group, told ABC News. "What the argument would be is that the three-year-shelf life is too short."

As soon as vials are filled with the vaccine, a three-year ticking clock to expiration begins. Poland says the FDA may have held off on signing off to try to get the vaccine to as many people as possible before this occurred.

However, demand is far outpacing supply. About 600,000 doses have been delivered and there are 1.1 million people eligible to be vaccinated.

Currently, the U.S. only uses the Jynneos vaccine, not another smallpox vaccine called ACAM2000 -- which the U.S. has in a stockpile -- because the latter can cause side effects in people with certain conditions, such as those who are immunocompromised.

But Poland says the vaccine should be used and people can be screened to make sure they don't have any conditions that put them at risk.

"I understand reluctance to use it but, especially if monkeypox really starts exploding, I don't think you'll have a choice at that point," he said. "I think if your choice is we've got nothing or we've got this, that's easy for me."

To increase the number of doses available, FDA Commissioner Dr. Robert Califf said during a media call on Thursday the agency has "identified a potential solution."

"We're considering an approach ... that would allow health care providers to use an existing one-dose vial of the vaccine to administer a total of up to five separate doses," he said.

The vaccine would be given in a smaller, shallower injection under the skin, a method Califf said would still be safe and effective but would allow up to five doses to be pulled from one vial.

Hesitation to declare a public health emergency

The HHS on Thursday declared monkeypox a public health emergency, 78 days after the first U.S. case was detected in May and about two weeks after the World Health Organization did the same.

It also comes two days after Biden named a national monkeypox team to help combat the outbreak and help increase the availability of tests, treatments and vaccines.

Larry Gostin, a former CDC and WHO consultant who has been advising the White House on monkeypox response, said the announcement could be a "turning point" in the nation's health response after a "lackluster start."

"It's coming very, very late," Gostin, also a professor of medicine at Georgetown University., told ABC News' "Start Here." "It's not a time to panic, but it's absolutely a time to get serious. And I hope that this will be a pivotal turning point for the administration after a lackluster start."

By issuing a declaration, HHS will be able to take a series of actions including accessing funds set aside for such an emergency as well as appointing personnel to positions directly responding to the emergency. It will also help speed up test and vaccine distribution.

"One thing that's been hampered from the beginning is money," Chin-Hong said. "Money means personnel, it means even delivering medications to patients, it means diverting people away from other activities temporarily to try to focus on one outbreak instead of focusing on 10 million other things."

Before the U.S. declared an emergency, New York, Illinois and California all declared their own emergencies. But without a national declaration, it meant states couldn't access federal resources.

"California, Illinois and New York might be able to cobble stuff from their own state funds, but they can't really use federal funds -- unless it's been like some puny money for random emergencies in the future -- because there's no dedicated monkeypox money from a federal level," he said. "You know, a lot of the efforts in each of the parts of the country is hampered by money."

As to why the U.S. took so long to declare a health emergency -- HHS Secretary Xavier Becerra cited "evolving circumstances" for the declaration -- experts say there are a few reasons.

One is to avoid further stigmatization of the LGBTQ community. So far, most cases in the U.S. have been reported among men who have sex with men, a group that includes people who identify as gay, bisexual, transgender and nonbinary.

Even though the CDC has said there is no evidence that monkeypox is a sexually transmitted infection and that anyone can contract the disease, Halkitis said health officials may have been worried about further discrimination of LGBTQ people.

"The other reason I think there's a hesitation is because I think people are exhausted with COVID," he said. "And the last thing people want to hear about is another public health emergency when we don't even have the last one under control."

ABC News' Devin Dwyer, Cheyenne Haslett and Karen Travers contributed to this report.

Copyright © 2022, ABC Audio. All rights reserved.

Adult at Illinois day care tests positive for monkeypox, children potentially exposed

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(NEW YORK) -- An adult at an Illinois day care center has tested positive for monkeypox, and a number of children may have been exposed to the virus, health officials in Illinois announced on Friday.

At this time, officials did not disclose the number of children that may have been exposed to the virus. Screening of children and staff from the day care, which is located in the Rantoul area of Illinois, near Champaign, is currently underway, and no additional cases have been discovered as of yet.

"All available state, local and federal resources are being deployed to assist families," state officials said during a press conference on Friday afternoon. "Pediatricians are on site, as we speak, to screen children for cases and they're mobile testing and vaccines for their families. Health officials will continue to stay in contact with families and provide information and resources in the coming days."

The day care has been cleaned, and it is still open, officials said.

"The people who have been exposed, potentially, do not need to be in quarantine, so they are being screened and assessed. Anyone with even a tiny little suspicion, we will put them in isolation pending any type of results, but they have the guidance for cleaning and they have done that probably a lot more than is even necessary," officials said.

The individual with monkeypox "also works in a home health care," and health officials have been in contact with the one client who has been impacted.

"The person with monkeypox is in isolation, is being medically monitored, and is doing well," officials added.

The disease is typically spread through prolonged skin-to-skin contact with infected people's lesions or bodily fluids, according to the Centers for Disease Control and Prevention. In addition to lesions, which can appear like pimples or blisters, the most common symptoms associated with monkeypox are swollen lymph nodes, fever, headache, fatigue and muscle aches.

Officials reported that Illinois Gov. J.B. Pritzker had been in touch with the White House, and at the state's request, "the Food and Drug Administration has authorized use of the vaccine for anyone under 18, without jumping through the normal hoops in this process."

"That means that anyone with their guardian's approval will be vaccinated today," officials said.

ABC News has reached out to the FDA and the White House for clarity on whether a formal authorization has been made for children to receive the JYNNEOS vaccine.

On Tuesday, the FDA confirmed to ABC News that "numerous" children have been granted access through a special permission process that operates on a case-by-case basis.

If a doctor decides a person under 18 was exposed to monkeypox and the benefit of the vaccine is greater than any potential risk, they can submit a request to the FDA. In a statement, the FDA said numerous such requests have been granted, but did not say exactly how many.

At this time, the majority of monkeypox cases confirmed domestically and globally in the current outbreak have been detected in gay, bisexual or other men who have sex with men. However, health officials have repeatedly stressed that the virus does not discriminate, and anyone exposed to monkeypox can contract the virus.

At least five children in the U.S. have now positive for monkeypox, according to state and local officials from across the country.

On Thursday, the Biden administration declared the current monkeypox outbreak to be a public health emergency in the U.S.

Globally, more than 28,000 cases of monkeypox have been confirmed across 88 countries, including 7,500 cases reported domestically.

Copyright © 2022, ABC Audio. All rights reserved.

Novavax's COVID-19 vaccine rollout off to sluggish start with just 7,000 doses in arms

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(NEW YORK) -- Following its emergency authorization last month, just 7,300 doses of Novavax's COVID-19 vaccine have been administered to Americans across the country, newly updated data from the Centers for Disease Control and Prevention (CDC) reveals.

According to John Brownstein, Ph.D., an epidemiologist at Boston Children's Hospital and an ABC News contributor, the sluggish start may be, in part, due to the fact that the vaccines were not immediately made available after authorization, and thus, there could be some reporting delays

The total Novavax doses represent just a fraction of the shots put into arms each day, though the overall number of vaccines administered has plummeted in recent months.

In addition, the vaccine has not been widely available, with just 385 sites initially offering the Novavax vaccine out of the more than 53,000 locations with COVID-19 vaccines, Brownstein said. However, in recent days, that number has jumped to 986 sites, which Brownstein suggested may help boost uptake.

"A mix of lower access, limited promotion and a slowing of the vaccination campaign means that Novavax has not been of high priority for remaining unvaccinated Americans," Brownstein said. "As supply increases, we could see increased access but it’s unlikely to make a real dent."

In July, the Biden administration secured 3.2 million doses of Novavax’s COVID-19 vaccine, in hopes that some unvaccinated Americans would get the shot.

A number of health experts had expressed their hope that some of the individuals, who are still hesitant to be vaccinated, would be more inclined to get the Novavax vaccine, because it is based on a more traditional protein-based technology, one already used for the flu vaccine and other shots, while Pfizer and Moderna vaccine platforms tapped a new genetic technology — with messenger RNA — to produce their vaccines.

"A more traditional delivery route has to be seen as incentive to convince those that have yet to roll up their sleeves," Brownstein explained.

However, early indicators suggest that the authorization has yet to substantially move the needle with the most hesitant Americans.

Even so, health experts previously told ABC News that no matter how widespread the use of Novavax's vaccine is, it will still save lives.

Nationally, there are still more than 26 million American adults who remain completely unvaccinated.

There has not been a significant bump in the number of people receiving a first COVID-19 dose since November 2021. Since then, the average number has steadily fallen to around 50,000 first shots, administered across all eligible age groups, each day.

Copyright © 2022, ABC Audio. All rights reserved.

Monkeypox vaccine available for kids on case-by-case basis, FDA says

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(NEW YORK) -- With over 6,000 cases of monkeypox confirmed in the United States, including five children, the demand for the monkeypox vaccine is high.

And while the current vaccine, JYNNEOS, is approved only for adults ages 18 and older, it has been administered to children in the U.S. on a case-by-case basis, according to the Food and Drug Administration.

The FDA confirmed to ABC News that "numerous" children have been granted access to the vaccine through a special permission process.

If a doctor decides a person under 18 was exposed to monkeypox and the benefit of the vaccine is greater than any potential risk, they can submit a request to the FDA. Only children with direct exposure are granted access, and even then access is decided on a case-by-case basis

The FDA declined to state exactly how many children have received the vaccine to date through this special permission process.

The JYNNEOS vaccine, delivered in a two-dose regimen, has not been tested through clinical trials in children.

There have been no "adverse events to date" in delivering the vaccine to children in the U.S., and similar vaccines have been tested in children without serious safety concerns, according to the Centers for Disease Control and Prevention.

"JYNNEOS contains a non-replicating Vaccinia virus. While JYNNEOS has not been studied specifically for children or adolescents, the same non-replicating Vaccinia virus in the JYNNEOS vaccine has been used in studies as part of vaccines against other diseases including tuberculosis, measles, and Ebola," the CDC said in a statement. "These studies included children as young as 5 months old, and no serious safety concerns were reported."

Given the case-by-case basis of administering the monkeypox vaccine, there is no availability for mass vaccination of children at this time.

Children under the age of 8 are among those the CDC considers at "increased risk" for developing more severe illness if infected with monkeypox, along with pregnant people, people who are immunocompromised and those who have a history of atopic dermatitis or eczema.

Experts are not sure why children are at increased risk for severe illness, but it may be due to their immune systems and the fact that "younger children are sometimes more susceptible to some viral infections," Dr. Richard Malley, senior physician in pediatrics, division of infectious diseases, at Boston Children's Hospital and a professor of pediatrics at Harvard Medical School, told ABC News.

Monkeypox, also known as MPX, is spread primarily through direct, skin-to-skin contact between someone who has the virus and someone who does not, according to the CDC.

Typically, the disease begins with a fever, headache, fatigue, chills and muscle aches. The disease is similar to smallpox, however, monkeypox also causes swollen lymph nodes.

Within one to three days of initial symptoms, those infected typically develop a rash either on their face or other parts of the body, according to the CDC.

Per the World Health Organization, the lesions -- or rash -- start out as dark spots on the skin before progressing to bumps that fill with fluid.

Antiviral medications such as Tecovirimat, which is available for children, are currently being used for treatment of monkeypox.

Officials in the U.S. and around the world have expressed concern that there are not enough monkeypox vaccines to address the emerging crisis. With demand increasing, U.S. health officials have reported that 1.1 million doses of the JYNNEOS vaccine will be allocated to states and jurisdictions across the country.

Moderna, the maker of a COVID-19 vaccine, said Wednesday they have initiated a research program to consider whether the company could create a monkeypox vaccine with mRNA technology.

Any new vaccine would still need to go through the regulatory authorization process, which can take weeks to months, even in special circumstances.

Now that the Biden administration has declared the current monkeypox outbreak a public health emergency, the FDA could move to issue an emergency use authorization for the JYNNEOS vaccine for children under 18.

The FDA told ABC News it would still need to go through a process to evaluate if it would want to authorize the vaccine for a younger population.

ABC News' Eric Strauss, Arielle Mitropoulos and Ivan Pereira contributed to this report.

Copyright © 2022, ABC Audio. All rights reserved.

7 ways to reduce your risk of monkeypox

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(NEW YORK) -- With the U.S. Department of Health and Human Services declaring the monkeypox outbreak a public health emergency as the number of cases continue to rise, the most important thing you can do is know your risk level. Monkeypox is still rare and most people have a low risk.

But if you are in a city where monkeypox is spreading, and in a community where it's spreading, you are at higher risk in this current phase of the outbreak.

The monkeypox outbreak first started spreading among men who have sex with men, a group that includes people who identify as gay, bisexual, transgender and nonbinary. The group continues to be at the highest risk. So far, the bulk of cases have been reported in large cities like New York and Los Angeles.

As the outbreak continues, the virus may soon start to spread further and begin to affect different demographic groups.

Experts interviewed by ABC News provided the latest on how to stay safe. Alongside these suggestions, the experts reiterated that at this time, the risk of transmission to the general population is low. But they agreed everyone should be aware of current outbreak and take steps to reduce risk.

Be alert: Avoid close or skin-to-skin contact with those who may have the virus

Direct, close, skin-to-skin contact "is considered to be the main route of transmission, which can occur in a variety of ways. It can occur just by day-to-day contact with a case of monkeypox, in close proximity, or can occur through intimate contact, as well as during sexual contact," said Dr. Wafaa El-Sadr, a professor of epidemiology and medicine at Columbia University.

Because monkeypox can spread during sexual intimacy, it's important to "be honest and forthcoming with your intimate partners" about risks and possible prior exposures, said Richard Silvera, professor of medicine at the Icahn School of Medicine at Mount Sinai.

The CDC says monkeypox is contagious from the start of symptoms until the rash has healed. Two to four weeks is the typical length of illness.

"You can have a rash in multiple areas of the body, and that rash can look like many things. It can look like a pimple, it can look like a little bump that mimics folliculitis which is when the follicle of the hair gets infected, can be painless or painful," said Dr. Robert Pitts, an infectious disease doctor at NYU Langone Health.

Don't share: Avoid sharing towels, clothing and bed linens

The virus can spread through contaminated objects including "clothing, bed sheets, towels, and other porous materials," says Dr. Anne Rimoin, professor of epidemiology at the University of California, Los Angeles.

While this form of transmission is not nearly as common as skin-to-skin contact, it is something to keep in mind when sharing items with others.

"This virus could live on those surfaces for a period of time and then spread to another person," Rimoin said.

The CDC also recommends avoiding utensils or cups used by someone with monkeypox.

General hygiene: Wash hands with soap and water or use an alcohol-based hand sanitizer

"Hand hygiene is the most important thing, not just for monkeypox but for any infectious disease," says ABC News chief medical correspondent Dr. Jennifer Ashton.

With hands being the vectors between all that we touch and where germs can enter-- eyes, nose, mouth -- hand hygiene is vital to staying healthy. Practices that have worked for the past two years, still work.

"Mask wearing, hand washing...if it works for COVID it'll work for monkeypox as well," says Silvera

Cover up: Being fully clothed may be safer, especially when encountering large crowds

To reduce the likelihood of skin-to-skin contact with someone who may be infected with the virus, wear clothing that covers your body.

The CDC says "festivals, events, and concerts where attendees are fully clothed and unlikely to share skin-to-skin contact are safer," when compared to similar events with minimal clothing and close contact.

"These are not events where transmission is likely occurring, but of course, if you feel like you're in a high risk category, you may want to exercise a little bit more caution," says. Dr. John Brownstein, an ABC News contributor and chief innovation officer at Boston Children's Hospital.

Disinfect: Wipe down surfaces that may be contaminated

Monkeypox is considered an orthopoxvirus, which are sensitive to many disinfectants, according to the CDC. They recommend disinfecting areas where someone with monkeypox has spent time, and for objects they may have used.

"At the same time, it's not like people will need to go back to those old COVID days where there was a lot of confusion and wiping down of groceries and disinfecting household items where there's literally no chance of any risk," says Brownstein.

For those specifically in areas of high transmission, or are encountering surfaces or objects used by someone with monkeypox, disinfecting may provide additional protection.

The CDC recommends using an EPA registered disinfectant.

If eligible, get vaccinated: Reach out to a local health department

The CDC currently recommends that vaccines should be administered to those at risk of developing monkeypox. This includes those that have been exposed to monkeypox as well as people who are aware that one of their sexual partners in the past two weeks has been diagnosed or people with multiple sexual partners in the past two weeks living in an area with known monkeypox. People should stay up-to-date with their local health department to determine eligibility requirements.

"If we had a lot more [vaccine] supply, we might consider vaccination of groups that have very dense social networks, like college colleges, students, prisons, living situations that would potentially allow for multiple contacts where there could be risk," says Brownstein.

Stay current: Be on the lookout for new information as it comes

"We're all going to have to kind of pitch it together and kind of figure this out as we go," said Silvera.

Even researchers and clinicians are learning more every day.

"I studied about [monkeypox] as an infectious disease physician, but just in May, I started to see and interact with monkeypox patients. So this has been a steep learning curve for me," said Pitts.

Before now, the number of monkeypox cases has been relatively low. We will continue to learn more about the virus as time goes on and the guidance from experts will evolve as a result. But experts emphasize that remaining calm is important.

"This is quite different from the Coronavirus in so many ways and therefore I think people should be aware, concerned, but at the same time should not really panic," said El-Sadr.

Copyright © 2022, ABC Audio. All rights reserved.

Biden administration declares monkeypox a public health emergency

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(WASHINGTON) -- Amid growing calls from health officials across the country, the Biden administration declared the current monkeypox outbreak to be a public health emergency in the U.S. on Thursday afternoon.

The declaration, which was made by the U.S. Department of Health and Human Services, comes a little less than two weeks after the World Health Organization designated the outbreak an emergency of international concern.

By issuing a declaration, HHS will be able to take a series of actions including accessing funds set aside for such an emergency as well as appointing personnel to positions directly responding to the emergency. It also gives Health Secretary Xavier Becerra significant flexibility to bend federal rules or waive requirements on government health programs like Medicaid, Medicare and the Children's Health Insurance Program.

"We're prepared to take our response to the next level in addressing this virus," Becerra said on a media call Thursday. "And we urge every American to take the process seriously and to take responsibility to help us tackle this."

A public health emergency declaration lasts for 90 days, but it may be extended by Becerra. There have been four national public health emergencies declared in the last 15 years.

"The public health emergency will allow us to explore additional strategies to get vaccines and treatments more quickly out to the affected communities. And it will allow us to get more data from jurisdictions so we can effectively track, and attack, this outbreak," Bob Fenton, the new White House monkeypox coordinator, said on the media call.

The CDC will now also now receive data from all jurisdictions reporting who is vaccinated as well as data on testing and hospitalizations.

Last week, New York became the first state to declare monkeypox a "disaster emergency," with officials calling New York City the "epicenter of the outbreak." Illinois and California soon followed, with both states reporting hundreds of confirmed cases.

There had been mounting pressure for the federal government to declare monkeypox a public health emergency, as confirmed cases have rapidly emerged in recent weeks.

"As the monkeypox virus continues to spread across the United States, I urge you to immediately declare a public health emergency so that the federal government can use every resource and tool available in its response and rapidly increase availability and access to vaccines, tests, and treatments nationwide," Rep. Carolyn B. Maloney, D-N.Y., chairwoman of the Committee on Oversight and Reform, said in a letter to HHS last week.

"The federal government must take every step possible to mitigate the threat monkeypox poses to the health of people in the United States before it is too late," she added.

Of the more than 26,000 cases reported globally, over 6,600 cases have been reported in the U.S., according to the Centers for Disease Control and Prevention.

Cases have been detected in 48 states, the District of Columbia and Puerto Rico. Montana and Wyoming are the only states that have yet to confirm cases.

The most common symptoms associated with monkeypox, a cousin of the smallpox virus, are swollen lymph nodes, fever, headache, fatigue and muscle aches. The rash may be painful and have lesions that look like pimples or blisters that can occur on the face and other parts of the body.

There have been no deaths due to monkeypox reported in the U.S. However, in recent days, several countries that have not historically reported monkeypox cases, including Brazil and Spain, have confirmed deaths due to the virus, according to The Associated Press.

People are typically infected by close person-to-person contact, including intimate contact. It is possible for the disease to also spread through droplets from face-to-face contact with an infected person, or through droplets on linens, sheets, clothes, and surfaces, when people are close for prolonged periods.

However, in the current outbreak, most of the spread has come from coming into prolonged skin-to-skin contact with infected people's lesions or bodily fluids.

Before the outbreak, most cases occurred in countries where the virus is usually found or endemic -- typically central and western Africa.

At this time, the majority of cases in the current outbreak have been detected in gay, bisexual or other men who have sex with men. However, health officials have repeatedly stressed that anyone can contract the virus and there is currently no evidence it is a sexually transmitted disease.

Officials have confirmed that at least five children in the U.S. have now tested positive for monkeypox, as well as a pregnant woman.

Over the weekend, the CDC warned in a health alert that some evidence suggests people with uncontrolled HIV and children younger than 8 years old could develop more severe illness if infected. In addition, while it is unclear if pregnancy puts someone at greater risk for more severe illness, there is a risk of transmitting the virus to the fetus during pregnancy, or to a newborn after birth.

The Biden administration, alongside global health officials, has vowed to ramp up the United States' response to monkeypox, as more cases have emerged.

Earlier this week, the White House announced they had appointed Fenton, who was acting administrator of the Federal Emergency Management Agency when President Joe Biden took office, as the White House coordinator for the monkeypox outbreak.

As monkeypox cases have emerged across the country, demand for vaccines has surged across the country, particularly in large metropolises like New York City.

In the coming weeks, HHS officials have reported that a total of 1.1 million doses of the JYNNEOS vaccine will be available to states and jurisdictions across the country.

Federal health officials said Thursday that more than 600,000 doses of the Jynneos vaccine -- which is approved by the Food and Drug Administration for smallpox and monkeypox -- have been delivered across the country.

To increase the number of doses available, FDA Commissioner Dr. Robert Califf said the agency has "identified a potential solution."

"We're considering an approach ... that would allow health care providers to use an existing one-dose vial of the vaccine to administer a total of up to five separate doses," he said.

The vaccine would be given in a smaller, shallower injection under the skin, a method Califf said would still be safe and effective but would allow up to five doses to be pulled from one vial.. Stretching the supplies could help "close the gap," Califf said. He added that a decision will be made in the coming days.

Copyright © 2022, ABC Audio. All rights reserved.

One dead, 11 sickened in Legionnaires' disease outbreak in California county


(NAPA, Calif.) -- Health officials are investigating a deadly outbreak of Legionnaires' disease in a northern California county.

Twelve residents of Napa County have been diagnosed and hospitalized with the rare lung infection since July 11, according to Napa County Public Health. Among those, one person has died and three people remain hospitalized, health officials said Wednesday.

As part of its investigation, the county has been testing human-made water sources, including cooling towers and decorative fountains, for the presence of the bacteria that causes Legionnaires' disease.

Preliminary results found "high levels" of the Legionella bacteria in a sample taken from a cooling tower at the hotel Embassy Suites Napa Valley, in the city of Napa.

The cooling tower has been taken offline, "which mitigates any ongoing risk to public health," and the county health department said it is continuing to identify any other sources that have unsafe amounts of the bacteria.

"Our joint investigation team continues to work with Embassy Suites staff to remediate the source of exposure," Napa County health officer Dr. Karen Relucio said in a statement. "Finding Legionella in one water sample is an important piece of the puzzle, but we must continue to investigate other cooling towers and water sources in the outbreak area, as it is common to find more than one source."

None of the 12 patients diagnosed with Legionnaires' disease have been identified as having stayed or visited the Embassy Suites hotel, health officials said.

An Embassy Suites by Hilton Napa Valley spokesperson told ABC News that the hotel is continuing to "cooperate fully" with the county's ongoing investigation.

"We are waiting for a full report with test results from the health department, however, remain diligent in our commitment to providing a safe, hospitable environment for all," the spokesperson said in a statement. "In keeping with that commitment and upon learning of their concerns, we immediately contacted our consultant and water treatment provider to ensure we were following the guidance set forth by the health department and began remediation."

Legionella bacteria grows in warm water and can become a health concern when it spreads in man-made water systems like cooling towers, hot tubs, decorative fountains and plumbing systems. People can get Legionnaires' disease by breathing in small droplets of water containing the bacteria.

Symptoms of Legionnaires' disease include cough, fever and difficulty breathing. It is not spread from person to person and can be treated with antibiotics when caught early.

People at higher risk of getting sick from Legionnaires' disease, a serious type of pneumonia, include those ages 50 and older, smokers and those with chronic lung disease or compromised immune systems.

The person who died in the Napa County outbreak was over 50 and had risk factors for "severe disease," health officials said.

"Although Legionnaires' disease is a rare infection, this is a reminder that the bacteria that cause it are common in nature and can be found in man-made water systems," Relucio said. "This means it's very important for owners and managers of water systems that can create aerosols to take steps to prevent Legionella from growing and spreading in water systems."

Health departments reported nearly 10,000 cases of Legionnaires’ disease in the U.S. in 2018, though the true number may be 1.8 to 2.7 times higher than what is reported, according to the U.S. Centers for Disease Control and Prevention. About one in 10 cases are fatal, the CDC said.

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Mom shares warning after 3-year-old son nearly dies from tick bite

Jamie Simoson

(NEW YORK) -- A Pennsylvania mom is sharing details of her son's near-death experience to raise awareness of Powassan virus disease, a tick-borne illness.

Jamie Simoson told ABC News' Good Morning America that her 3-year-old son Jonny was swimming in June when she noticed a tick on his shoulder, which she said she quickly removed.

"It was the tiniest tick," said Simoson. "I, you know, grabbed it with a little pair of tweezers. It came right off."

Two weeks after removing the tick from her son, Simoson said she received a phone call from Jonny's day care providers that he had a headache and was "not himself."

Within hours, Simoson said Jonny developed high fevers and became severely fatigued, sleeping all day and night and losing some speech recognition.

"It was so hard to watch," said Simoson. "This is the little boy who's been attached to me since the day he was born, and he didn't even want to be held. It was just heartbreaking."

Jonny was hospitalized, and doctors discovered swelling in his brain. He underwent a four-hour infusion of antivirals and antibiotics, which helped him improve quickly, according to Simoson.

Once he was discharged from the hospital, Simoson said doctors diagnosed her son with Powassan virus disease, a tick-borne illness that causes an infection of the brain.

The virus, which is spread to people by infected ticks, is rare. However, cases have been on the rise in recent years, with most occurring in the northeastern and the Great Lakes regions of the U.S., according to the Centers for Disease Control and Prevention.

Symptoms for Powassan virus, according to the CDC, may not develop until as long as one week to one month after the tick bite. Typical initial symptoms of the virus include fever, headache, vomiting and weakness.

If the virus progresses to severe, it can infect the brain or the membranes around the brain and spinal cord, causing confusion, loss of coordination, difficulty speaking and seizures, according to the CDC.

"People, when that happens, can develop altered mental status, meaning that they may be more sleepy than usual, have difficulty waking up, they may experience seizures, maybe some unusual behaviors, severe headaches," Dr. Robert Posada, a pediatric infectious disease specialist at Mount Sinai Kravis Children's Hospital, who was not involved in Jonny's care, told GMA.

Around 1 in 10 people who develop severe disease from Powassan virus die, according to the CDC. Among those who survive, around half will have long-term health problems like memory issues, recurring headaches and loss of muscle mass and strength.

While there are treatments to support people with Powassan virus, there is no medication specifically used to treat this illness.

Simoson said her son Jonny is experiencing left-side weakness and some remaining cognitive delays, but she said she and doctors are hopeful he will make a full recovery.

There is no vaccine for Powassan virus, so the CDC says the best way to protect against the virus is to protect yourself, your pets and your home from ticks, which typically live in grassy, brushy, or wooded areas.

Experts also say early detection is key, so to seek medical treatment immediately if symptoms of Powassan virus disease are present.

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Officials suspect 2-year-old died after being in hot car, marking 14th hot car death this year

Marin Tomas/Getty Images/STOCK PHOTO

(SCRANTON, Kan.) -- Officials in Scranton, Kansas, suspect heat played a role in the death of a 2-year-old, who died after being found unresponsive in a car Sunday afternoon.

It would mark the 14th hot car death this year, based on data from Kids and Cars Safety, a national nonprofit that tracks hot car deaths and aims to prevent vehicle-related risks to children and pets.

Osage County Sheriff Chris Wells said the child apparently "got into the car" by themself and had not been left in there by an adult, the Topeka Capital-Journal reported.

Details on the child's name and gender have not yet been released.

Every year, approximately 38 children die from being left in a hot car, according to Kids and Cars Safety, with 87% of them age 3 and under.

As the U.S. copes with more heat waves this summer and temperatures in the Midwest, South and West continue to soar into the triple digits, there is a concern for parents about hot car deaths. One parent, Peter Hansen, opened up about the issue on social media.

"I have severe anxiety about leaving our kids in a hot car on accident," Hansen, a father of three in Chicago, wrote in a LinkedIn post. "It's 100 degrees in Chicago today and the heat is intense across the country. Working from home has me multitasking more than usual, which can distract me from the kids some days, especially if driving on a work call. This is simply a post to make sure your kids are not left in your car in this heat."

The 40-year-old told "Good Morning America" an episode with two of his three kids one morning gave him a scare and prompted him to reflect on the dangers of hot cars and how easily things can go wrong.

"We got doughnuts and came back in the house," Hansen recalled. "It's still 7 in the morning -- it wasn't 100 degrees yet -- but five minutes later, I was in the house and my 4-year-old walked through the door five minutes later, she's like, 'Daddy, you forgot me.' And it was like, I swear I saw her get out of the car … but I was like, 'Oh my gosh.' It really terrified me that I thought both of them got out of the car together like they normally do."

Why do hot car deaths happen?

Amber Rollins, a director at Kids and Cars Safety, said the issue is often misunderstood and even dismissed by many parents and caregivers.

"I think the No. 1 misconception is that this will never happen to me and that it only happens to bad parents and nothing could be further from the truth," Rollins told "GMA." "I've worked with families that this has happened to for 16 years and they are engineers, school teachers, principals, nurses, doctors, you name it. It's the type of people that I aspire to be as a parent, the kind that read every safety book about the most expensive car seat and strapped him in so tight and covered every outlet. That's the kind of person this is happening to."

According to Rollins, hot car deaths have also been trending upwards for the last three decades, with an exception during the last two years of the pandemic when more families stayed at home.

"In the '90s, we realized children were being killed by overpowered airbags and children are still safer riding in the back seat. We moved them to the back seat because that's where they're the safest. However, now they're out of sight of the driver," Rollins explained. "So they're in the back seat, they're rear-facing now until age 3 or even longer, depending on the size of the child. And that car seat looks the same for the driver whether there's a baby in there or not."

"This is not like parents didn't just all of a sudden overnight become neglectful and irresponsible," she added. "This is an unintended consequence of moving them to the back seat."

How to prevent hot car deaths

Multiple solutions have been proposed to avert a hot car death before they occur. Among the high-tech options include carbon dioxide detection, lidar or light detection and ranging technology, car alarm systems, car camera systems and car seats with weight sensors, each with its own pros and cons.

A new idea, called "Cabin Awareness," from Toyota would use radar technology, powered in part by a car's battery, to notify drivers who have left a Toyota vehicle that a child or a pet remained inside the car.

Brian Kursar, chief technology officer for Toyota Connected North America and Toyota Motor North America, has led the "Cabin Awareness" project since its inception in 2018 and said the project is moving now toward a testing phase with May Mobility, a Michigan-based company that develops autonomous technology, including vehicles.

"The 'Cabin Awareness' concept uses millimeter-wave radar to detect micro-movements and so micro-movements really are the things that a camera can't see. So it's also able to understand breathing, heartbeat, and ultimately provides us a solution to something that we've not been able to really touch, which is the ability to understand life in a vehicle," Kursar explained to "GMA," adding that radar could "see through things like cloth" and go beyond a camera's line of sight.

Toyota's "Cabin Awareness" could link up to a driver's cell phone, a smart device – such as smart lights, a smart speaker, or smart TV – inside their home, or possibly other Toyota vehicles in an environment such as a parking lot and ultimately, contact emergency services when other alerts go unanswered.

"Based on our algorithms, we're able to understand where in the vehicle that movement is coming from. And then we're able to now take a number of options to escalate, to let the customer know that there is life potentially at risk in a vehicle," Kursar said.

"We see this as an opportunity not just to contact the customer. You can give the system a list of contacts such as grandma, right, such as your neighbor, right, and these are additional folks that can start helping to resolve this problem with the vehicle," Kursar added. "Maybe we can now do a vehicle-to-vehicle ping to say, if you're within proximity of a child or an adult at risk in a car, now you have this almost community outreach where people in their cars, they turn on their cars, and it says, [someone in] a green Sienna within your proximity, may be at risk for heat exhaustion."

For now, "Cabin Awareness" is not available in Toyota vehicles just yet and the timeline for a potential rollout will depend on testing results.

In the meantime, Kids and Cars Safety's Rollins recommends several solutions that parents can keep in mind and adopt this summer.

Adopt the "look before you lock" habit.

"We want to use that habit system to prevent it from happening," Rollins said. "No matter what, even if the child is not with you, open the back door and check the back seat. Every single time you leave the car."

"It takes two seconds," she continued. "And it's a great way to make sure you're never forgetting anything, including your children or inanimate objects that aren't as important but make that a 100% habit."

In addition to being left in a car, a child or pet can gain access to a car when they're unlocked, so Rollins also emphasized the importance of utilizing car door locks. "You want to keep your car locked 100% of the time, even if you don't have children. Little ones can get into neighbors' cars. It happens all the time. You want to keep keys and remote openers out of reach of children 100% of the time and childproof your home."

"You want to check the inside trunk and floorboards of all vehicles in the area immediately, even if they're locked," Rollins added. "A lot of times, kiddos will get in and they try to get out and they push the lock button. And so people don't think they're in there if it's locked, but they definitely can be."

Use a visual reminder.

Rollins suggests keeping a physical object, like a diaper bag, in the front seat or playing a kid's song to remember that you're traveling with your child. "If you're not a diaper bag person 100% of the time, create a reminder object in your car. So throw a stuffed animal in the car seat. And then anytime you put the child in the car seat, that stuffed animal comes up to the front seat with you as your visual cue that the baby is with you," Rollins said.

Enlist the help of others.

"If you take your child to daycare or anyone, a family member that watches them, whoever it is, you want to make a policy with them. They would call you immediately if your child didn't show up as scheduled and I mean immediately," said Rollins. "That one phone call could have been the difference between life or death for hundreds of children."

Make kids aware of the hazards of a hot car.

"Talk to your kids about how dangerous it is to get into a car without a grown-up and talk to them about never allowing a grown-up to leave them in the car," Rollins said.

Use stick-on door alarms.

Inexpensive door alarms can be more accessible for parents than full-fledged home security systems in the short term and peel-and-stick options are sold online and in stores.

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Dallas City Council committee passes resolution to limit impact of Texas abortion law

Shelby Tauber/Bloomberg via Getty Images, FILE

(DALLAS) -- A Dallas City Council committee passed a resolution Tuesday looking to limit the impact of Texas's strict abortion law.

The council's Quality of Life, Arts, and Culture Committee voted to adopt the ordinance, which directs law enforcement to make investigating or prosecuting any allegation related to abortion outcomes their lowest priority.

It also limits city funds from being used to compile reports of abortions that were performed, to "conduct surveillance" to determine whether an abortion has occurred and to relay the information to any governmental agencies.

The resolution will be presented to the full council for a vote Aug. 10.

"I believe that we have to do what we can at every level of government to push back on legislation that takes away our rights, specifically when it comes to women's rights," Councilman Adam Bazaldua, who spearheaded the resolution, told ABC News. "It's our job as local leaders to preserve quality of life for residents and access to health care."

Bazaldua said it was vital the resolution was passed before Texas's so-called trigger law goes into effect.

Most abortions were already illegal in the state prior to the Supreme Court's reversal of Roe v. Wade in June. However, after the decision, a near-total ban went into effect with very limited exceptions.

When the "trigger law" is enforced on Aug. 25, performing an abortion in Texas will become a felony punishable by a fine of up to $100,000 and possibly up to life in prison.

Dallas is not the only Texas city that has attempted to affirm its support of abortion rights.

In June, Denton -- 40 miles northwest of Dallas -- was the first in the state to adopt a resolution directing police to make investigating abortions a low priority and, last month, the Austin City Council approved a resolution similar to the one passed in Dallas known as the Guarding the Right to Abortion Care for Everyone or GRACE Act, which effectively decriminalized abortion within city limits.

In addition to the measures also passed in Dallas, the Austin resolution also launched a public information campaign about vasectomies, explaining that the burden of preventing pregnancies "disproportionately falls on women."

Lastly, the Austin resolution prevents employment and housing discrimination based on whether someone is pregnant or has had an abortion.

"As a father of a 10-year-old daughter, I find it unfathomable to raise a young woman in a time when she has less rights afforded to her than her grandmother did in her lifetime," Bazaldua said. "And I think it’s important for this issue to be strongly considered when voters go to vote this November."

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New study warns young children may be susceptible to eating disorders

Catherine McQueen/Getty Images

(NEW YORK) -- Children as young as 9 years old have engaged in disordered eating behaviors, according to a new analysis published in JAMA this week.

The analysis, which was published Monday and based on data from nearly 12,000 children, showed that 5% of children -- both boys and girls -- engaged in binge eating, one of many types of disordered eating behaviors.

"It starts younger than a lot of us may think," ABC News Medical Correspondent Dr. Jennifer Ashton said on "Good Morning America" Wednesday.

Disordered eating behaviors can lead to eating disorders, according to the National Institute of Mental Health. Eating disorders include anorexia nervosa, where someone may avoid or severely restrict the amount of food they eat; bulimia nervosa, where someone may overeat and then vomit or overexercise afterward; and avoidant restrictive food intake disorder (ARFID), an extreme version of picky eating, where someone is selective about the foods they eat.

Researchers say such issues are common: More than 28 million in the U.S. are living with an eating disorder, which often starts during the teenage years.

"When they found 9- [and] 10-year-olds starting to engage in binge eating, that really shifts our timeline to try to be more aware earlier and try to intervene," Ashton said.

How to spot warning signs of an eating disorder

Parents may often be the first to notice disordered eating behaviors at home. Here are some red flags to watch out for:

  • A sudden change in appetite
  • Sudden avoidance of meal times
  • Frequent calorie counting
  • Overexercising
  • Poor body image or constant focus on weight or talk of weight gain or weight loss

What parents can do

If parents notice their child may be developing or already have an unhealthy relationship with food, Ashton recommends seeking professional help. As a starting point, parents can begin by initiating a conversation with their child's pediatrician.

Ashton added that parents should keep their child's privacy in mind and anticipate kids may act out, especially when they're nearing their pre-teen years.

If you or someone you know is battling an eating disorder, contact the National Eating Disorders Association (NEDA) at 1-800-931-2237 or NationalEatingDisorders.org.

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Monkeypox case trajectory could outpace current vaccine supply, vaccine expert says

Antonio Perez/Chicago Tribune/Tribune News Service via Getty Images

(NEW YORK) -- The U.S. is currently in a race to have the necessary tools and medicines to stop the growing spread of monkeypox, and it may be an uphill battle, according to one vaccine expert.

Dr. Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine in Texas, spoke with ABC News Live Tuesday about the latest developments in the spread of the virus. Hotez said he's concerned about the trajectory of new cases that are being reported throughout the country and the world.

As of Wednesday, 6,326 monkeypox cases have been confirmed in all states except Montana and Wyoming, according to the U.S. Centers for Disease Control and Prevention. No American has died from the virus, according to health officials. There have been 25,391 cases worldwide as of Wednesday, according to the CDC.

Hotez said the current monkeypox vaccine, JYNNEOS, is effective, but said the current supply may not be enough.

"It's not dire yet, but the feeling is unless we work pretty quickly we could get there," he told ABC News.

Monkeypox is spread through skin-to-skin contact, and although most known cases in the current outbreak are among people who identify as gay or bisexual, anyone can get it, Hotez said. As of Wednesday, five children have contracted the virus, the CDC said.

Hotez said the small supply of the vaccine, which was commissioned a decade ago, is the result of U.S. health officials letting a stockpile expire "inexplicably" and doing nothing to replenish it.

"When the outbreak began we only had a few thousands doses and we're playing catchup ever since," Hotez said.

The Food and Drug Administration announced last week that it had inspected and approved the manufacturing of 786,000 more doses of JYNNEOS for distribution in the U.S. and that more than a million doses will be available in the coming weeks.

On Tuesday, President Joe Biden announced FEMA administrator Robert Fenton would serve as the White House National Monkeypox Response Coordinator and Dr. Demetre Daskalakis would serve as the White House National Monkeypox Response Deputy Coordinator.

The pair will "will lead the Administration’s strategy and operations to combat the current monkeypox outbreak, including equitably increasing the availability of tests, vaccinations and treatments," according to a statement from the White House.

Hotez said Biden's appointees are qualified to lead the task and said one of the issues that they're going to have to tackle is the vaccine supply. In addition, he said they will have to determine if there will be an increased call to use the antiviral drug tecovirimat, a.k.a. TPOXX, to treat patients while the country replenishes the vaccine supply.

"The problem is this: We don't have the full armamentarium of tools to control it," he said. "So we're in a race trying to…accelerate the control tools, [so] that we have the diagnostics, the drugs and the vaccines versus that steep trajectory of cases."

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Moderna considering creating an mRNA monkeypox vaccine amid growing demand for shots

Maddie Meyer/Getty Images

(CAMBRIDGE, Mass.) -- Amid growing concerns over the potential threat of monkeypox, executives from Moderna said Wednesday they have initiated a research program to consider whether the company could create a monkeypox vaccine with mRNA technology.

"We're obviously very aware of the monkeypox concern and obviously very sensitive to recent announcements," Moderna President Stephen Hoge said during an investor call.

He went on, "We did initiate a research program. We are tracking that very closely and obviously, given the recent public health announcements and increasing concern about availability of vaccine supply, we are beginning to look at what it would take for us to use our platform and to provide a monkeypox vaccine -- both [to] intervene in the current and the current epidemic but also to try and address long-term issues of supply in this public health threat."

Domestically and globally, officials have been vocal in their concern that there are not enough monkeypox vaccines to address the emerging crisis. With demand increasing, officials from the U.S. Health and Human Services (HHS) have reported that a total of 1.1 million doses of the JYNNEOS vaccine for monkeypox, a two-dose regimen, will be allocated to states and jurisdictions across the country. Approximately 1.5 million Americans are currently considered eligible for vaccination, the Centers for Disease Control and Prevention (CDC) told ABC News last month.

Moderna will continue to track the monkeypox virus "very closely" given the recent increase in cases domestically and globally and discussions remain pre-clinical, Hoge said. No decision on whether the company will move forward with the creation of such a vaccine has been made, he noted.

"Our platform is pretty well established and our ability to rapidly scale has been demonstrated. If we were to go after a monkeypox clinical development program, it would be to very quickly progress toward an approvable set of endpoints in a clinical study," he explained.

As seen with the rollout for the COVID-19 vaccines in the U.S., any new vaccine would still need to go through the regulatory authorization process, which can take weeks to months, even in special circumstances.

"We need to engage with regulators and other consultations to determine what that path would be," he added.

Hoge noted that COVID-19 is still a "larger public health threat" than monkeypox at this time and the company remains focused on preparing boosters for the fall.

Of the more than 25,000 monkeypox cases reported globally, over 6,300 cases have been reported in the U.S., according to the CDC.

Cases have been detected in 48 states, the District of Columbia and Puerto Rico.

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New government reports on long COVID lay out existing help, what more should be done

Sebastian Condrea/Getty Images

(WASHINGTON) -- The federal government took an initial step forward in its response to long COVID-19 Wednesday, releasing two reports that compile what federally-funded services are available to people already suffering from the condition, and what research efforts are still needed to better understand how to address it.

"These are initial reports. They're a significant step, but they're one step," said Dr. Rachel Levine, the U.S. assistant secretary for health for the U.S. Department of Health and Human Services, in an interview with ABC News.

"And the work begins tomorrow, as we work on the implementation of the recommendations to the report moving forward," Levine said.

The reports stemmed from a presidential memorandum issued by President Joe Biden in April, which created an interagency task force on long COVID headed up by HHS Secretary Xavier Becerra and Levine, who will now oversee a new office specifically focused on long COVID at the department.

The HHS Office of Long COVID Research and Practice "will be charged with the implementation" of both plans produced by HHS and updating both regularly -- but doing so will hinge on funding for staff and operations in the next annual budget.

To start, it's not yet clear how common long COVID is. Estimates of how many people experience long-term symptoms after a COVID-19 infection vary between 5% and 30% of people, while a recent large study by the Centers for Disease Control and Prevention found that age might be a factor.

One in five adults under 65 has a health condition related to a previous COVID infection, while one in four people over 65 does, the CDC study found. Women, too, might be disproportionately affected.

A lack of data on who these people are -- from race and ethnicity to gender -- also leaves gaps in how equitable the U.S. response is.

"While racial disparities in Long COVID are relatively unexplored, it is well understood that some racial and ethnic minority communities are disproportionately impacted by COVID-19," the HHS report published Wednesday said.

Only 65% of over 61 million COVID cases reported by early 2022 included race and ethnicity data, according to the report.

Addressing who has long COVID and whether everyone is equitably getting both the treatment and the government-supported services to help them, like disability benefits, is a large focus of the report.

"We want the parent who lost their job to know that there is income and job assistance available. We want health care providers to know that technical guidelines and resources can help them do their job and that research is on-going to continue to improve their ability to treat and care for their patients. Simply put we want to assist the American public in addressing the longer-terms effects of COVID-19," HHS spokesperson Tara Broido told ABC News.

There are 200 services for people with long COVID listed in the report, including technical guidelines for health care providers working with long COVID patients.

“We're going to figure out what the gaps are and where we need additional resources,” Levine said.

And while there are already studies underway across the government, including at the National Institutes of Health, the CDC and the Department of Veterans Affairs, the HHS reports on long COVID call for faster research and implementation.

"The current lag in research being translated into practice is simply not acceptable in the current environment," the report finds.

"We must aggressively innovate how we do research and accelerate the pace of research to meet the challenge of the moment. … We need to rethink how we disseminate research and translate findings into practical solutions more quickly."

Levine called the two reports, and specifically the research plan, a "living document" that should serve as "guideposts for government action."

"This is an initial step in a long term project. So I think it will help people, but then it's going to inform how we move forward to help people over the long term," Levine said.

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Fifth child tests positive for monkeypox in US: What parents should know

ABC News

(NEW YORK) -- As monkeypox continues to spread across the U.S., the number of children infected with the virus is growing as well.

At least five children have tested positive for monkeypox since July, including two each in Indiana and California.

The other case was reported in an infant, a non-U.S. resident, who was tested while traveling through Washington, D.C., federal officials confirmed last month.

Children under the age of 8 are among those whom the Centers for Disease Control and Prevention considers at "increased risk" for developing more severe illness if infected with monkeypox, along with pregnant people, people who are immunocompromised and those who have a history of atopic dermatitis or eczema.

Below, experts answer seven questions parents might have about monkeypox and how it may impact kids, as overall cases across the U.S. continue to climb.

1. As a parent, how concerned do I need to be about monkeypox?

At this time in the outbreak, parents "do not need to panic" about the virus, according to ABC News chief medical correspondent Dr. Jennifer Ashton, who is also a board-certified OB-GYN.

"They should be aware of what's going on with this, as they are with any medical headline," Ashton added. "They should know what's going on in their community and they should take the appropriate steps after discussing any concerns they have with their pediatrician."

2. How is monkeypox spread?

Monkeypox, also known as MPX, is spread primarily through direct, skin-to-skin contact between someone who has the virus and someone who does not, according to Dr. Richard Malley, senior physician in pediatrics, division of infectious diseases, at Boston Children's Hospital and a professor of pediatrics at Harvard Medical School.

"That could be through intimate contact," said Malley. "It could also be through just contact with somebody in the family who has an unsuspecting lesion and lesion unfortunately touches another individual."

Shared items like towels, clothes or bed sheets could also possibly spread the virus if used by someone with a monkeypox lesion, according to Malley.

"If somebody is infected with MPX, they really need to be very careful with who they interact with and how they interact with those with other people to try to avoid spread as much as possible," he said.

According to the CDC, monkeypox can also spread through contact with an infected person's respiratory secretions and prolonged face-to-face contact.

"So far it does not seem to be the major mode of transmission for this virus in the current epidemic," said Malley. "But that is of course one of the things that we need to monitor very closely."

3. Does my family need to wipe down surfaces or avoid shared spaces like playgrounds?

Because monkeypox is spread primarily through skin-to-skin contact, parents at this point do not need to be overly concerned with their child becoming infected by touching things like doorknobs in public spaces or shared toys, according to both Malley and Ashton.

"While that possibility remains, I think it does not mean that parents or anyone should be concerned about touching doorknobs or going to the grocery story or touching objects that are out on the street, for example," said Malley. "That is not thought to be a very likely way for MPX to be spread, or for most viruses to be spread."

Ashton said that people who live in high-transmission areas for monkeypox may want to wipe down surfaces as an extra precaution, noting, "It is possible that this virus can be left on gym equipment, just like it can be left on clothes."

However, she added that hand washing is more important than wiping surfaces to prevent the spread of disease.

"Hand hygiene is the most important thing, not just for monkeypox but for any infectious disease," Ashton said.

4. How can I tell if my child has monkeypox?

Unfortunately, the symptoms of monkeypox can look like other viruses -- including flu and other rashes -- so experts recommend seeking medical care as soon as symptoms show, especially if your child has been in contact with someone who has monkeypox.

Typically, the disease begins with a fever, headache, fatigue, chills and muscle aches. Unlike smallpox, however, monkeypox also causes swollen lymph nodes.

Within one to three days of initial symptoms, those infected will typically develop a rash either on their face or other parts of the body, according to the CDC.

Per the World Health Organization, the lesions -- or rash -- start out as dark spots on the skin before progressing to bumps that fill with fluid.

Malley said parents should seek medical care for any type of rash on their child's body that does not look like something they have had previously.

"The rash of MPX, as we are now learning, can look very different in different individuals for reasons that we don't quite understand," said Malley. "You really need to be cautious with anything that might look like a MPX rash."

Monkeypox is diagnosed by testing the lesions to identify whether genetic material of the virus is present, according to Malley.

5. Why are children at increased risk with monkeypox?

Experts are not sure, Malley said.

It may be due to their immune systems and the fact that "younger children are sometimes more susceptible to some viral infections," he explained.

In Africa, where monkeypox originated, the most severe but rare cases of the virus have typically involved inflammation of the brain, according to Malley.

Ashton said that while there have so far been no deaths associated with monkeypox in the U.S., it's important to stay vigilant as the disease spreads.

"As the numbers grow, based on sheer math, it is not impossible that we will see a death here in the U.S.," said Ashton, adding that monkeypox has a "spectrum of severity" when it comes to complications. "There have been deaths in Africa associated with monkeypox."

6. Is there a monkeypox vaccine for kids?

The current vaccine for monkeypox is available to people ages 18 and older. However, the JYNNEOS vaccine can be offered on a case-by-case basis via a special permission process through the U.S. Food and Drug Administration to those with known monkeypox exposure.

Antiviral medications such as Tecovirimat are currently being used for treatment of monkeypox, which is available for children.

More common treatments may also be used to help treat patients who are experiencing pain due to monkeypox lesions, according to Malley.

7. How should I best protect my child from monkeypox?

The best thing parents can do for both themselves and their child, according to Malley, is to pay attention to the virus -- but try not to panic.

"I think it would be very unlikely that daycare or a camp or school would be a major focus of transmission of this virus as we understand it currently," he said. "But of course, it's important for all of us to be vigilant."

Malley said the key for parents concerned about monkeypox is to be aware of their child's surroundings and not interact with people they know have been infected with monkeypox.

"The importance for parents is that if they know anybody in their surrounding, in their environment, in their family who has a suspicion of being infected with MPX, then of course that individual needs needs to isolate themself," he said. "In general, people who have been diagnosed with MPX have been told and are being very careful because they do not want to be responsible for transmission."

The CDC has released safety guidelines for people with monkeypox, urging those infected with the virus to "remain isolated at home or at another location for the duration of illness."

According to Malley, monkeypox lesions are considered to be infectious until they are fully crusted over.

ABC News' Arielle Mitropoulos and Cheyenne Haslett contributed to this report.

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