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CDC Telebriefing Transcript

West Nile Virus Season 2003-04 and
Update on Monkeypox Investigations

June 9, 2003

MR. RUTZ: I'm Dan Rutz, communications specialist with the National Center for Infectious Diseases at CDC. Originally we had billed this news conference for the dual purpose of apprising you of our preparations for addressing the West Nile virus season, which has already begun across the country, and also to bring you up to date on the monkeypox outbreaks in the upper Midwest that we've reported over the weekend.

Due to important developments in the monkeypox investigation, we've decided to pretty much make that the dominant theme today. However, it will also be permissible for you to ask questions about West Nile fever.

Regarding West Nile, at 10:45 (a.m.) Eastern time and at 1:15 (p.m.), there will be a satellite feed of the West Nile virus PSA, the public service announcement, and also some b-roll, vector-borne b-roll that will be fed as well. Those times again are 10:45 (sic) a.m. and 1:15 p.m. (Editor's note: This will take place Tuesday, June 10, 2003).

Our primary presenter for this news conference is Dr. Stephen Ostroff, deputy director of the National Center for Infectious Diseases here at CDC. And participating by telephone will be Dr. Karen Midthun, who is the acting deputy director of medicine for the Center for Biologic Research and Evaluation at FDA. She is a vaccine expert. And also on the line, Dr. Jesse Goodman, who is director of that same FDA center. Dr. Goodman is an expert in blood safety and can respond to questions regarding that issue and West Nile. Dr. Ostroff.

DR. OSTROFF: Thank you very much, Dan. We fairly hastily called together a telebriefing on Saturday afternoon and we realized that many of the media weren't necessarily apprised of that telebriefing and may not have had an opportunity to have their questions addressed, and thought that it was very important to try to put together another opportunity for you to have your questions answered concerning the monkeypox situation. I think it's very important to stress that it's still quite early in the investigation. We are working highly collaboratively with the involved states in the Midwest in looking into the circumstances of these rash illnesses among persons who have had contact with these exotic animals.

I will give some updated information on what we do know at this point. There are 33 cases of rash illness that are under investigation by the three Midwest states that have previously been identified--Wisconsin, Indiana, and Illinois. It's important to point out that these are cases that are under investigation. Very few of these cases at this point have been confirmed as having monkeypox and it is not entirely clear that all of these will eventually be confirmed or will be included once we have developed a standardized case definition that will be used across all of the state health departments. We're working at this point to develop those standardized case definitions, and so these numbers will continue to be in a little bit in a state of flux.

It is important to point out that our laboratories have confirmed that the infection indeed does belong to the monkeypox virus family. We have confirmed this in four of four human specimens that we have tested to date, including having evidence of the presence of the virus in culture at this point. We certainly do expect to continue to have results today on additional human and animal specimens.

It's also important to point out that we will be providing some updated numbers from what I just reported later on in the afternoon once we have additional discussions with the states that are involved.

Let me give you a little bit of information on the profiles of the patients, at least that we're aware of to date. There have been no fatalities. Patients are in various stages of recovery. Among these 33 individuals, although we don't have complete information on all of them, seven have been hospitalized and six of them currently remain in the hospital. The age range of these individuals is between 4 years of age and 48 years of age, with a median of 32 years of age.

The vast majority of them--20 of the 24 on which we have information at this point--have had a rash which was fairly characteristic of what one would see with a disease like monkeypox, and the vast majority of these individuals have also experienced fever. More than half of them also had respiratory symptoms.

We continue to work with our partners at the state health departments and the departments of agriculture to look into the circumstances of the animals. The investigations center around prairie dogs and Gambian giant rat shipments. We are very actively involved in doing trace-backs and trace-out investigations in collaborations with the involved states.

I think it's important to point out that the investigation is certainly ongoing. A lot of the information is quite preliminary. At this point, we don't know how many animals or humans may be involved and we don't know the extent and scope of the problem in terms of the number of affected areas.

As has been previously pointed out, at least some of the individuals that have been involved have procured animals at what are called pet swap meets, and so it may be difficult necessarily to identify the origins of those animals. So people may--even though they may hear the names of the distributors and the specific pet shops that maybe have been identified up to this point, there may be other individuals with ill animals that may not necessarily make the connection because they don't recognize that their animals are potentially from that source. So that's why we feel it's very important that any individual who has one of these animals that may be exhibiting signs and symptoms of illness, make sure that they contact their local and state health departments to report this illness, that it's very important that they also work with their local and state health departments about how to work with the local veterinary authorities and local veterinarians about how to deal with these animals, as well as to make sure, if they are bringing these animals in for care, that they call ahead to the veterinarian to let them know so that reduces the potential that there might be other opportunities for other animals to be exposed, to be able to then, potentially, potentiate the infection in other types of animals.

We do know that all of the involved individuals up to this point are persons who have had direct contact with ill prairie dogs or, in one instance, an ill rabbit that was in contact with the ill prairie dog. We do not have any information at this point that suggests person-to-person transmission, although we continue to look into that possibility.

With that, I think that what I'll do is I'll close and we'll go to questions. We have persons both here in the room as well as that are on the line. What we'll do, as is traditionally the case in these press conferences, we'll go back and forth in each direction. So why don't we start with taking a question from the persons that are here in the room. Go ahead.

QUESTION: Thank you, Dr. Ostroff. [inaudible] from the Wall Street Journal. Picking up with your last comment, how concerned are you that this has spread beyond its current situation, in other words, transmission from prairie dogs to humans who come in contact with it. How worried are you that it could spread to other more common animals, cats and dogs and therefore to humans?

DR. OSTROFF: Well, again, most of the experience with this particular virus has been in what appears to be its natural range in Africa. And so, similar to being that we--you know, this discussion is both in terms of monkeypox as well as West Nile, where you have to keep in mind that experience in one location doesn't necessarily indicate what might happen when a pathogen like this is introduced into a new location. So I think that we have to keep a relatively open mind.

I think based on the knowledge and information about the host range for monkeypox, I think the biggest concern is the potential for it to be transferred to other types of rodents and what we refer to as lagomorphs, which are rabbits. Those would be the animals of particular concern. And indeed, as we worry about human health, we would also be concerned about the potential for exposure of humans that are in contact with these animals.

Why don't we take a call from the telephone?

OPERATOR: Thank you. Once again if you wish to ask a question, please press 1 at this time. And our first question will go to Seth Borenstein from Knight Ridder Newspaper. Please go ahead.

QUESTION: Thank you very much, and thank you for doing this, Dr. Ostroff. In terms of person to person transmission, I know you have not had any information on that so far. In terms of the African experience how contagious is this on the normal scale you often give us, and are you doing--is there any isolation involved with the people who are either suspected or confirmed?

DR. OSTROFF: Thank you for that question. Let me try to address the first part of your question. There indeed has been some studies in Africa, and again, how directly applicable those studies would be to the situation here in North America, one could speculate about that. But there were indeed studies looking at cases of monkeypox and looking at their household contacts. And in those circumstances, the secondary transmission rate to other household members that were in very close direct contact with those individuals was somewhere on the order of about 10 percent. I believe about 40 individuals out of 380 some household contacts, and that would probably be the best study that's available.

And so when you think about transmissibility of the other orthopox virus that many of us are concerned about which is smallpox, it doesn't appear to be nearly as infectious to others, as smallpox is, but certainly there is some experience to suggest that this virus can be transmitted from one person to another, although it certainly appears, based on the experience in Africa, that after several generations of transmission from one individual to another, that that transmission tends to not be sustained.

In terms of recommendations for isolation, we have overnight put somewhat recommendations on our website, which I would certainly refer you to concerning recommendations for ill individuals that may not necessarily need to be in the hospital.

In this current situation we feel it's important that persons who require hospitalization for medical reasons be in the hospital, but if they do not require hospitalization we believe that it is fine for them to be cared for at home. We do recommend that individuals who are still ill and who have lesions that have not necessarily scabbed over, do place themselves in isolation at home.

Why don't we take another question from here in the room?

QUESTION: Hi. David Walkberg [ph] from the Atlanta Journal Constitution. I understand that the initial outbreak of these cases was through to be possibly smallpox. Could you talk a little bit about how the investigation proceeded and how much that was a concern?

And then my second question is: what sort of actions can be or might be taken against the exotic pets dealers?

DR. OSTROFF: Well, again, we're very early in the investigation at this point. We first heard about the possibility of there being a orthopox-related illness last Wednesday evening. We fairly immediately dispatched a team to collect specimens. They returned on Friday, and we confirmed the diagnosis on Saturday, and reported that out almost immediately. We too are very interested in looking into the specific details of when information may have been available. I think it's very preliminary at this point and we need to do a lot more thorough investigation of that particular issue.

In regard to your second question about recommendations for the exotic pet industry, I think it's also a little premature to make specific recommendations regarding that.

Why don't we take another call from the phone lines?

OPERATOR: Thank you. We'll go to the line of Detra Henderson from Denver Post. Please go ahead.

QUESTION: Thanks again for doing this. I'm not quite certain what sort of screening is done on exotic pets. When they come in from other countries is there some sort of quarantine? Are there blood tests that are done?

DR. OSTROFF: I think that that's a question that's best referred to other agencies that more specifically deal with animals, exotic animals that are coming into the country. I believe that would be the U.S. Department of Agriculture and U.S. Fish and Wildlife. I will point out that CDC has a history of involvement in animal species that may be capable of transmitting diseases to humans. Most of that involvement has been in the area of nonhuman primates or monkeys, and we've had a long-standing policy based on experiences and concerns about disease like Ebola virus, and tuberculosis with a required quarantine for those animals.

Why don't we take another call from--another question from here in the room?

QUESTION: Mark [inaudible] with CBS News. Two questions. First of all, you said there was 33 cases that are sort of being reviewed.

DR. OSTROFF: Right.

QUESTION: How many confirmed cases of this do we have?

DR. OSTROFF: Well, at this point very few of these individuals would be what we would consider confirmed, i.e., they have definitive laboratory evidence of the presence of monkeypox. At this point we have identified the presence of the virus in four individuals in which specimens have been tested here, and we've made a definitive diagnosis of monkeypox. As mentioned, there are a lot of specimens that we've received in our laboratories, and we would certainly anticipate that those numbers will rise because we know most of these individuals certainly have an illness that's very, very suggestive of the disease, and in addition to that, have the appropriate exposure as far as being in contact with ill prairie dogs.

So we think that it's very likely that a substantial proportion of these individuals will be confirmed as having--

QUESTION: So confirmed as 4 for now, but 4 and rising?

DR. OSTROFF: Four and rising is the best way to say it.

QUESTION: Okay. Second question. Let's just talk about this sort of general fear factor when these strange diseases suddenly pop into our radar. I mean we've had SARS, we had West Nile, we have all these weird diseases that seem to be making their way across the ocean to us.

I realize that it's early still in this investigation, but how do you size up what is the general public health threat here?

DR. OSTROFF: Well, I think as you indicate, we're always very concerned. I mean this is an era of emerging infectious diseases, and as you've pointed out, we certainly had the introduction of the other virus that was mentioned earlier, as far as this particular briefing, West Nile. And we know that apparently from a single introduction into New York City in 1999, that this virus has now spread, as of last year, to 44
different states and the District of Columbia as well as Canada, and some evidence of further dispersion into Latin America. And so whenever you hear about a new virus being introduced into an ecosystem where it's not been present before, you have to be very, very concerned about the public health threat, particularly when it's a disease that we know, although not nearly--that does not nearly have the mortality rates associated with smallpox, certainly can produce severe disease, can be transmitted from person to person, and can then set itself up in a persistent animal reservoir. And one of the reasons that we've been trying to get the information out as rapidly as possible and be able to track down where all of these animals may be, is to eliminate the possibility that we will set up some sort of a persistent reservoir. So it is a concern.

Why don't we take a call from the line?

OPERATOR: And we'll go to the line of Robert Bizell (ph) with NBC. Please go ahead.

QUESTION: Yes, Steve, to follow up on what you were just saying, isn't it very difficult to think that a prairie dog, a rat, or a rabbit would not escape from captivity and into the wild? Because it seems to be such a common occurrence. And what would be the consequences if that happened?

And I have a second question. There was a 1997 outbreak of monkeypox in the Congo, the former Zaire, that caused an enormous amount of concern at the time with the World Health Organization. Why was that episode such a cause for concern and explain that to us, but first, the introduction of these creatures into the wild.

Thanks.

DR. OSTROFF: Well, again, you know, we don't have--we don't necessarily have all of the answers. That's one of the issues that I think that we're concerned about and why at least several of the affected states have made very specific recommendations about not releasing these animals into the wild. We realize that a lot of people that might have a pet prairie dog might be very concerned about the potential to be exposed to this particular virus and might choose to either release them or euthanize them or do something else.

And I think it's very important to point out that in several of these states they have made very specific recommendations, and I think have actually issued regulations that individuals not release these animals into the wild because of the potential for them to then expose other animals and raise the potential for setting up an enzootic cycle in the local wildlife.

We don't know how likely that is to occur. It's certainly a concern and it's one that we have to be cognizant of. I mean, one of the other possibilities is that this could theoretically get into some other animals, as it did with the one rabbit, and that even if we do manage to bring the prairie dog problem under control, that it would raise the opportunity for potential cases from other sources.

So I think it's very important that we keep our guard up in terms of watching for cases, both over the short term as well as the longer term.

Why don't we--

QUESTION: And the question about Africa?

DR. OSTROFF: --a question from here in the audience?

QUESTION: Melinda Adams with CBS. How fearful should people be? And when you're talking about transmission, just the general handling of one of these ill prairie dogs, it's just as simple as that?

DR. OSTROFF: Well, I think that, you know, based on the information that we have to date, it looks like most of the ill individuals have occurred in several very specific settings. One is in veterinary clinics, the other is in several pet shops, and the third is in individuals who directly purchased and handled prairie dogs. And so I think concerns for the wider community that might not necessarily have contact with prairie dogs is--you know, there's a remote possibility at this point of coming in contact with this particular virus, particularly since we're working so hard to be able to identify persons who may have actually purchased these prairie dogs and, in addition to that, make sure that we can do follow-up of contacts and make sure that ill individuals are kept in isolation.

So hopefully we think that this would limit the likelihood of creating a wider problem. So I think for the average citizens, I would not necessarily be concerned at this point about being exposed to monkeypox, but--and also to know that we're working very hard to try to make sure that we can contain the problem.

[Inaudible question.]

DR. OSTROFF: We know that many of these animals that appear to be involved were ill. Some of these animals did indeed bite the individual that subsequently developed illness, and in some instances, because they had skin lesions, it appears that simply handling the prairie dog was sufficient to cause people to become ill.

We also do know that some of these prairie dogs exhibited some respiratory illness, and it may be that simply having been in very close direct contact with the prairie dogs themselves may have been sufficient to transmit the infection. So I think we, you know, have to be a little cautious because we don't necessarily have all the information that we need at this point about how exactly the virus may be transmitted. But it certainly looks to us like direct contact with one of these ill animals appears to be required.

Why don't we take a call from the line.

OPERATOR: We'll go to the line of John Bottrek (ph) from Washington Facts. Please go ahead.

QUESTION: Yes, thank you. Dr. Ostroff, I was wondering if you could speak a little bit about how the previous efforts that have gone into preparing to track and contain SARS might have affected the containment efforts in this outbreak.

DR. OSTROFF: Well, I don't necessarily see a connection between the two of them.
Certainly we've been working quite hard, and when I say "we," the entire public health system at both the federal, state, and local level to be able to recognize and investigate cases of SARS. But I don't think that that's necessarily impacted the monkeypox situation one way or the other.

Why don't we take a call from here in the room.

QUESTION: Daniel Yee with Associated Press. What were you going to tell us today about West Nile virus? Is there anything coming up that's different from last season? And can you also give us a quick SARS update?

DR. OSTROFF: Right. Thanks for that question. You know, we're right now very early in the West Nile transmission season. We have had information--in fact, I did bring some information with me in case any West Nile questions came up, at least what's been reported to the ArboNET system, which is the system that we use to gather information about West Nile not only in humans but also in birds and horses, which were the other two reservoirs of concern. At this point into the system, we've had reports from 17 different states, all of them states that were previously recognized to have West Nile activity. In 13 of those states we've had reports of birds; in five of those states we've had reports of infection in horses; and in two of those states there have been reports of mosquitoes.

So, you know, when you compare it to our experience from last year, this is the time indeed when a lot of the states are starting to recognize West Nile activity. And one of the reasons why we did want to at least bring up West Nile is that, while we're all concentrating on monkeypox, it's important to point out that we are starting to get into the West Nile transmission season. And this is the time for everyone in the public--because now this is virtually from one coast to the other--to be looking at breeding sites around their home as well as starting to think about using protective measures, because the virus is country in circulation.

I'll also mention that in addition to those 17 states, there have been--although it's not been updated in the system, it will probably be updated later on this week--there have seven additional states which have also over the last couple of days reported their first evidence of West Nile for the season. So we're certainly getting into the West Nile season.

As far as SARS is concerned, as of this weekend the number of probable cases in the United States, with 68, with the number of suspected cases at 311, for a total of 379, the number of reports that are coming in to CDC have declined very markedly. And that's, I think, a reflection of what the larger global situation is.

Why don't we take a question from the line.

OPERATOR: We'll go to Larry Altman from the New York Times.

QUESTION: Yes, Steve, could you put monkeypox in some perspective in terms of its infectiousness and contagiousness vis-a-vis other viral or infectious diseases? Where does it stand against chicken pox? Where does it stand versus other common ailments, so the public can understand. And also, to give the answer to Bob Bazell's question that didn't get answered before about Africa.

DR. OSTROFF: Let me try to address your first question. You know, monkeypox has really not been as thoroughly studied as many of the other viral illnesses that we're all much more familiar with, such as diseases like measles and chicken pox and certainly a lot of the information, from our experience, with smallpox. Most of the recognized--in fact, virtually all of the recognized illnesses until the current episode, has occurred in fairly remote parts of Africa, where it's not necessarily been very easy to study the transmission patterns of this particular infection.

We do not believe that this is as transmissible or as infectious as some of the other more common viral infections such as influenza or such as measles, or certainly such as smallpox would be if that particular virus was once again to emerge in a population. So it's not on that order of magnitude. Again, we believe that most of the transmission, if it did occur among humans, would be an individual who would be in direct contact with people who had sores or lesions. And so that is a very important factor in terms of transmission--or in direct contact with the animals that were ill.

As far as your second question about the outbreak that occurred in 1997 in the DRC, the Democratic Republic of Congo, I think everybody was concerned because, again, this is a virus that we simply don't have a lot of information about. And being that this was a remote population, this was an area with a lot of civil strife and there were a lot of populations in that area that were malnourished and in a state of famine, I think that there was a lot of concern about the potential for this to spread much more widely. And that was why it was so important for teams to go and investigate the circumstances and make sure that it was understood and could be as contained as well as potentially possible.

Why don't we take a question from here in the room.

QUESTION: Just a quick clarification. I think you mentioned of the 33 monkeypox suspected cases that some were--

DR. OSTROFF: Cases under investigation.

QUESTION: Under investigation. Some are vet clinic workers, some are pet shop workers, and some are prairie dog owners. Can you give us a breakdown, if you have that, among those groups?

DR. OSTROFF: Hold on just one second. Let me see if I have that with me. I believe that six of the individuals were in the veterinary
setting. There are either three or four individuals that were in the pet shop setting, and the rest of them have been among family members of persons that owned prairie dogs.

Why don't we take a question from the line?

OPERATOR: Thank you. We'll go to the line of Rick Rice from Washington Post. Please go ahead.

QUESTION: Hi. Thanks, Dr. Ostroff. Can you say some more about what happened when the first evidence of these infections came to the attention of state authorities and then CDC. It does not sound to me like anything close to what happened in the season ender of "E.R." kicked in. And after all the talk we've heard for months about smallpox preparedness, it doesn't sound like any alarm bells necessarily went off. You haven't said whether homeland defense was notified. What went on to make sure that this was not a smallpox outbreak?

DR. OSTROFF: Well, again, we're still in the information-gathering stage here. I don't have all of the specifics and the details about what occurred with the earliest cases and what the circumstances of those cases were.

I think that the question that you raise is a very good question. It's an issue that we're very concerned about as well. And I think that we have to wait until we gather a little bit more information as well as have further discussions with the involved states to be able to determine exactly what was known at various times and what steps were taken.

So I think it's a little bit premature to raise the alarm that maybe there were some missed opportunities here. I think it's simply something that we'll have to look into and get more information as we progress with the investigation.

Why don't we take another question from here in the room?

QUESTION: Leslie Wade of CNN. How long before this will be contained? Your best guess. And do you think that the numbers will rise before it is contained?

DR. OSTROFF: Well, those are both great questions, and I'm not sure they're questions that we can answer yet because we've simply not known about the situation for long enough.

I would fully anticipate that based on the publicity and the assistance that we've had from the media in getting the information out about the problem, and certainly based on what we've seen since we first made the announcement on Saturday afternoon, there have been additional illnesses that have been recognized as a result of people making the connection that there have been individuals in contact with ill prairie dogs. And I would certainly anticipate that there are lots of other people that might be out there that are concerned about, you know, some recent skin lesion or some recent respiratory illness may be related to the fact that they've been in contact with prairie dogs.

And so I would anticipate that the number of calls that would come in and the number of cases that would be under investigation would certainly rise.

As to how rapidly this could be contained, again, that's another answer that's going to be very difficult to answer because it's simply too soon. We don't have all the information that we need about exactly the circumstances and how many of these animals might potentially be out there. So I think it's a little too premature to speculate on that.

Why don't we take a question from the line?

OPERATOR: We'll go to the line of Richard Knox with NPR. Please go ahead.

QUESTION: Yes, thank you. Hi. A couple of things.

One, I wondered whether you are concerned about the possibility that even if the infected prairie dogs don't get released, that there may be a potential of infection of the mice and rats--you know, wild mice and rats, that is--in the pet shops and distributors' warehouses, or wherever these prairie dogs might be, that might be a vector for spread into wild populations and whether you're looking at, say, antibody levels or whatever from those wild populations.

And, secondly, I wondered if even--I realize that CDC doesn't control the traffic in these things. I wonder if you have any sense at this point of the magnitude of traffic in Gambian rats or in prairie dogs.

DR. OSTROFF: Thanks for those questions. Again, I think it's a little premature, since we're so early in the investigation, to speculate about the potential for the virus itself to move from the affected prairie dogs to other animals that might be running around either these facilities or, it's also important to point out, at least some of these individuals lived in fairly rural settings where, you know, there might be other types of critters running around the environment.

I think, you know, we have to be concerned about that, and it is something that I'm sure we'll be working on with our partners at the state and local level to be able to make sure that we minimize those types of opportunities.

And your second question was?

QUESTION: [inaudible] even in a ballpark, a sense of what the traffic is?

DR. OSTROFF: Oh, I'm sorry, yeah. We have very, very preliminary information. I think that the bottom line is that there aren't very many shipments of these Gambian giant rats that come into the United States. And so I think that the trafficking in Gambian giant rats is probably relatively limited, but we don't have all of that information at this point.

Why don't we take another question from here in the room?

QUESTION: Thanks very much. I was wondering if I could ask another question about West Nile.

DR. OSTROFF: Sure.

QUESTION: If you could just tell us a little bit more about what you've done this year to prepare for--you expect the numbers to rise over last year, or do you think your efforts may start to pay off?

DR. OSTROFF: Well, again, it's hard to have the crystal ball to know what might happen this season because we don't really understand all of the interacting factors about the environment and the host and the virus itself to know what might happen over the next several months.

Last season's West Nile outbreak was basically unprecedented for an arboviral infection in the United States in recent memory. There were more than 4,000 human cases that occurred. There were a variety of novel transmission modes that occurred as well. And whether or not this season will be a replay of what happened last year, it' sa little too early to tell that.

I think that from the standpoint of the public health community it's really important for all of us to be prepared that this season could have the magnitude of what we saw last year. We all certainly hope that that's not the case, but if I was--you know, certainly where I live, I'm working on taking appropriate precautions, and I certainly use personal protective measures when I'm engaged in outdoor activities, and I would make the same recommendation to the public.

I think Dr. Goodman is on the line, if he wants to discuss specifically what's being done concerning some of the other novel modes of transmission, particularly the issue that came up as such a big issue last year with the blood supply. Let me try to turn it over to him.

DR. GOODMAN: Can you hear me fine there, Steve?

DR. OSTROFF: Yes.

DR. GOODMAN: Okay. Well, thank you. Yes, you know, since being engaged with CDC and others last summer and fall in investigating and responding to the problem of a number of cases of West Nile virus transmission by blood transfusion, FDA has really been working very intensively with the diagnostics and blood industries as well as CDC to begin to get blood donor screening testing available. And this has been so far a fairly remarkable success story in that just within those few months, there will be at least two different tests available for widespread use and study under FDA's investigational provisions for this season.

And thanks to the partnering with these industries and the CDC, these screening tests will be targeted towards screening blood donations in high-incidence areas. We think that should really significantly enhance blood safety while these tests are being evaluated.

One thing we learned last year is that in many cases there are very, very small amounts of virus in the blood of some individuals, so there's a need for very sensitive tests. This is also complicated by the fact that blood transfusion recipients may receive large volumes of materials. So we'll be working with these manufacturers and CDC and the blood community to really carefully evaluate the sensitivity of these tests and how they perform in the field.

Because this may not be a hundred percent protective in terms of keeping potentially infected blood out of the system, and particularly while the tests are in the developmental and study phase, we have revised our guidance which is in place that also helps address the problem by dealing with issues of trying to exclude donors who have significant illness before donation, those who develop illness after donation, and trying to be sure that we deal with investigating those situations and keeping potentially implicated blood products out of the transfusion screen to also augment safety.

But, in summary, we've come a long way in a few months. We're still very, very concerned about this. We're going to have to see how these tests perform. But it has been a positive story in terms of cooperation and moving on the basis of federal science out into the private sector.

DR. OSTROFF: Thanks very much.

Why don't we just take a couple of more questions. Why don't we take one from here in the room.

QUESTION: Talk for a second, if you would, about animal-to-animal transmission. Does the animal--the sick animal have to bite a healthy one or just be in the presence of a healthy one?

And the second question is: With the sick prairie dogs, what are you doing with those?

DR. OSTROFF: Thanks for those questions. I'm not the best one to be able to answer some of the questions about the veterinary issues surrounding how monkeypox may move from one animal to the other. So I think we probably have to get back to you about the specifics of that. I assume that there probably are different modes of transmission from animal to animal depending on the type of illness that they have.

As far as the recommendations for individuals that have ill pets, I think that, you know, if you look at what we put up on our website over the night, we do very strongly make recommendations that they contact their local and state health departments; and that, again, if they're going to bring the animal to the veterinarian that they call ahead to the veterinarian and make sure they're aware of the fact that they may be bringing in an animal that has this particular virus so that they could make sure that they are able to separate them away from other animals--sort of almost the same thing that we've done, you know, in terms of the recommendations for people who may be seeking health care for SARS.

And so at this point, as far as what specifically gets done with the animals, obviously if there's a suspicion that they're ill with monkeypox, we would like to be able to get samples from those animals and make sure that we can
determine what the scope of the problem is.

QUESTION: [Inaudible].

DR. OSTROFF: We know that some of the animals actually died, and we do know that some of the animals were euthanized to be able to detect it.

QUESTION: [Inaudible]?

DR. OSTROFF: I don't have that number with me. You know, you're probably talking relatively small numbers of animals at this point, probably somewhere in the area of a dozen or so.

Can we take a question from the line?

OPERATOR: Sure. We'll go to Marilyn Marcione [ph] from Milwaukee Journal. Please go ahead.

QUESTION: Hi, doctor. Thanks for doing this conference call again. I have a couple of questions. I wonder if you could go over a case breakdown of the states where these 33 suspected cases are, how many in each? And you mentioned that you'd be updating these later today. I wondered where and in what format we'd learn that.

And also whether other shipments of rats or prairie dogs in other states are being investigated, or a temporary federal ban is being considered?

DR. OSTROFF: In terms of the numbers, I mean, some of these have been reported by the various states. I believe in Wisconsin, the number of cases that are currently being reported by them is 18, and in Indiana there was an announcement that came out last evening of 10 cases that are under investigation, and the information that we have from Illinois was 5 individuals that are under investigation. Obviously, these are not all confirmed, and they're still being worked on to make a determination about whether or not these would be individuals of concern.

We will be having discussions with the states later this afternoon, and we do plan, as we've been doing with SARS, to be able to get to the point once we have a standardized definition of providing updated national numbers on a daily basis.

Can we take another question from the line?

OPERATOR: We'll go to the line of Tina Hesseman [ph] from St. Louis Post Dispatch. Please go ahead.

QUESTION: Hi. I wanted to ask about what measures are taken to try and contain the outbreak. Will you be offering the smallpox vaccine to people who have perhaps come into contact with ill animals, and is there any evidence to suggest that vaccinating someone post exposure with the smallpox vaccine would protect them from monkeypox as it does with smallpox?

DR. OSTROFF: Thanks. Those are great questions. We're actually having very active discussions almost as we speak, with the Advisory Committee on Immunization Practices around some of those issues, so that we can come up with the optimal recommendations about whether or not it would be appropriate to use the smallpox vaccine in this situation. So I think you should anticipate hearing a little bit more about that over the hopefully not-too-distant future.

There certainly have been some animal studies that have been done as well as some of the information that's been gathered from the outbreaks that have occurred in rural Africa that do suggest that there is some protective effect. I don't know how much information is available about its efficacy in a post-exposure situation as opposed to individuals that had been previously vaccinated. And so hopefully the experts will be able to get together that have had some experience with this vaccine with monkeypox to be able to discuss that.

I don't know--being that Dr. Midthun is on the line, whether she has any comments about that?

DR. MIDTHUN: This is Karen Midthun. Can you hear me?

DR. OSTROFF: Yes.

DR. MIDTHUN: No. I think you've summed it up very well, Dr. Ostroff. There are discussions with the ATIP that are ongoing and that will be looking at this issue to see what exactly is known and how the vaccine might best be used, and of course, we at FDA would work with CDC to make vaccine available as is determined would be most appropriate.

Dr. Goodman, did you want to add anything to that?

DR. GOODMAN: No. Totally agreed, we'll work together with CDC on this.

DR. OSTROFF: Let's take one more question from the line and then we'll bring it to a close.

OPERATOR: We'll go to the line of Mark Vittorio [ph] with WITI in Milwaukee. Please go ahead.

QUESTION: Thanks, doctor, for taking my call. I guess the big question we have here in Milwaukee is if you could talk to us about the stages of the illness? What does it mirror, mimic? And also we noted a fair amount of the prairie dogs that were connected with monkeypox in Wisconsin have been sent to the CDC. You mentioned a little bit earlier about what happened to those. Can you give me an update on the status of those animals and the testing that's being--

DR. OSTROFF: Thank for that question. Regarding the second point that you raise, we do have a number of specimens that we received here. I believe that we do have evidence in some of these animals of infection. I can't tell you exactly how many. There's a lot of specimens that are being moved down here, both from prairie dogs as well as specimens from gambian(?) rats. We don't have final results on all of them. They should be forthcoming over the next day or two since most of these specimens just came in over the weekend.

Thank you all very much. I just want to refer you to the CDC website. Check it later in the afternoon for a transcript of this briefing and also any later information we might have. Documents related to monkeypox will be posted.

[End of conference call.]

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