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Monkeypox Home

CDC Telebriefing Transcript

Monkeypox Investigation

June 7, 2003

MODERATOR: Ladies and gentlemen, thank you for standing by and welcome to the CDC conference call. At this time all participants are in a listen-only mode. Later we will conduct a question and answer session. Instructions will be given at that time. Thank you.

I would now like to turn the conference over to our host, Mr. Dan Rutz. Please go ahead.

D. RUTZ: Thank you, David. Good afternoon. I am Dan Rutz with the CDC National Center for Infectious Diseases Communications Office and I want to thank you for joining this teleconference on such short notice.

We have information today that’s important to the public health relative to the recent outbreak of pox-like illness among persons in close contact with pet prairie dogs in the upper Midwest. On the line to provide specific information about these cases and to answer your questions will be Dr. James Hughes, Director of the National Center for Infectious Diseases at the Centers for Disease Control and Prevention, that’s CDC, here in Atlanta; in Madison, Wisconsin, Dr. Jeffrey Davis, who is the Chief Epidemiologist for the state and Chief Medical Officer for the Wisconsin Division of Public Health; from Chicago, Dr. Mark Dworkin, State Epidemiologist for the Illinois Department of Public Health; and also Dr. Deric Whitaker, Director of the Illinois Department of Public Health; from Indianapolis, Dr. Robert Teclaw, Indiana State Epidemiologist; in Milwaukee, Dr. Seth Foldy, Health Commissioner for the City of Milwaukee; and in Marshfield, Wisconsin, Dr. John Melski, Dermatologist and Medical Director of Clinical Informatics at the Marshfield Clinic; and one more, Dr. Peter Jahrling, Scientific Advisor for the U.S. Army Medical Research Institute for Infectious Diseases.

Dr. Hughes will now quickly bring us up to date on the state of the investigation and we will then open the line to your questions. Dr. Hughes?

DR. HUGHES: Thank you very much, Dan. Good afternoon, everyone. Let me thank you in advance for joining us late on a Saturday afternoon, on a very short notice, to hear an update on information on an investigation that is currently in progress. This represents a collaborative effort involving state and local public health officials in Illinois, Wisconsin and Indiana, all of whom will be represented on this call, and it illustrates the sort of partnership that’s required to address emerging microbial threats.

Since early May, 16 cases of a febrile-rash illness have been reported in the upper Midwest. Thirteen of these have occurred in residents of Wisconsin, two in residents of Illinois and one in a resident of Indiana. All of these cases involved persons who had been in close contact with recently acquired pet prairie dogs that became ill.

Characteristics of the illness in people include initial symptoms of fever, chills, (background noise)… and muscle aches. Approximately a third of these persons also reported a dry, non-productive cough. Several days later these individuals developed a rash that began as papules or bumps, but progressed through stages involving vesicles, pustules and subsequently, crusting. At least (someone breathing into phone)… of these persons have been hospitalized. Fortunately there have been no deaths.

Scientists at the Marshfield Clinic in Wisconsin recovered … isolets from an ill patient and from a prairie dog. Images obtained from electron microscopy show an organism that appears to be from the pox virus family of viruses. Samples from several of these patients have been tested at (background noise)… and more testing is in progress.

Preliminary findings, as of today, indicate that a likely causative agent is a virus that is either Monkeypox virus or a very closely related virus to Monkeypox, which would make it a member of the orthopox family of viruses. Further characterization of the virus is in progress.

All of the patients reported direct or close contact with prairie dogs, most of which were sick. In two patients human-to-human contact with lesions also occurred. Some prairie dogs have died from the illness that they experience, while others recovered. The prairie dogs were sold by a Milwaukee animal distributor in May to two pet shops in the Milwaukee area and during a pet swap that occurred in northern Wisconsin.

The Milwaukee animal distributor had obtained prairie dogs and a Gambian giant rat that was ill at the time from a northern Illinois animal distributor. Investigations are under way to trace back the source of the prairie dogs and the Gambian rat and the subsequent distribution of animals from the Illinois distributor. Preliminary information suggests that animals from the Illinois distributor may have been sold in other states.

From the standpoint of infection control considerations, the investigation suggests that the primary route of transmission is by close contact of people with ill prairie dogs or Gambian rats. However, other routes of spread cannot be excluded in some cases.

We are learning as we go here. We have developed some interim recommendations for infection control that will be modified as we learn more. For hospitalized patients, currently we are recommending standard airborne and contact …. For the veterinary world we are recommending that veterinarians use personal protective equipment, including gloves, a surgical mask or an N95 respirator and gowns when examining sick rodents, especially prairie dogs and Gambian giant rats. As always, we are urging people in both the human healthcare and the veterinary healthcare settings to practice very aggressive personal hand hygiene.

A little bit of background information on Monkeypox. Human Monkeypox is a rare zoonotic viral disease that appears to be transmitted from animals and that occurs primarily in the rainforest countries of Central and West Africa. In humans, the illness produces a vesicular rash that is clinically similar to smallpox.

In areas in Central and West Africa limited person-to-person spread of the virus has been observed in household settings. Case-fatality rates in Africa — and these, I would emphasize, tend to be remote and certainly medically under-served areas of Africa — have been reported to range from one percent to 10%. Limited studies done in the area have focused on animal reservoirs for Monkeypox virus and have indicated that non-human primates, rabbits and some rodents are susceptible to this virus.

There are some things that we know and many things that we don’t know at this point. In terms of what we know, the illness in humans and animals is most likely caused by Monkeypox virus or a very closely related variant. Transmission appears largely to occur from animals to humans. We can’t rule out the possibility of some human-to-human transmission. The clinical illness is as I have described it. No one has been severely ill and, as I mentioned, there have been no deaths.

The source of the ill prairie dogs has been traced as far back as an Illinois distributor, but look-back investigations are in progress. In addition, the investigations are in progress to determine downstream distribution of these prairie dogs and the Gambian rat.

What we don’t know is the source of the Gambian rat that the Illinois distributor had and the scope and distribution of imported Gambian rats into the United States in general. We don’t know the geographic distribution of different animal species from the Illinois distributor. We don’t know the total number of persons who may have been exposed to infected animals. And we don’t know the effect of Cidofovir on this virus. We also don’t know the genetic sequence of this virus, though genetic sequencing efforts are in progress as we speak.

In terms of public health implications, the reason that we wanted to have this interaction today is that it’s very important that physicians, veterinarians and the public should be aware of this very unusual outbreak and be on the lookout for symptoms of fever and rash illness following exposure to prairie dogs or Gambian rats. The public, if they experience illness in themselves or family members, should report this promptly to their physicians, and physicians, in turn, should report the source of illness promptly to local and state public health authorities. The public should also report illness in pet prairie dogs and Gambian rats to veterinarians for additional guidance.

This experience is yet another reminder of the importance of the need for the clinical community, the public health community, and the veterinary community to work closely together in addressing zoonotic diseases, diseases that are transmitted from animals to people.

We will be issuing a Health Alert Notice this evening from CDC to provide additional guidance to state and local partners.

Thank you very much for your attention and your participation this afternoon. We will be happy, now, to take questions.

D. RUTZ: Thank you, Dr. Hughes. We are ready now, David, for questions.

MODERATOR: Our first question comes from the line of Marilynn Marchione with The Milwaukee Journal. Please go ahead.

M. MARCHIONE: Thank you very much, all of you, for doing this. I have several questions. I hope you will indulge (audio lost)…. My first question is you’re calling this a Monkeypox-like virus; can you say anything about whether this appears to be a novel virus or just a novel introduction into the country?

DR. HUGHES: Marilynn, thank you very much for the question. We are in the very early phases of characterizing this virus. So far we have serologic evidence, evidence from preliminary chain-reaction in tests on a small number of patients that indicate that the virus is consistent with being Monkeypox virus. There are different variants of Monkeypox virus and we are not far enough along with the molecular characterization to be absolutely certain that this is a Monkeypox and then to be able to say, assuming it is, which variant it is most closely related to.

M. MARCHIONE: My next question is have we ever seen, or has CDC ever before characterized, Monkeypox virus in the United States?

DR. HUGHES: To my knowledge this is the first evidence of a Monkeypox-like virus causing an immunity-acquired infection in the Western Hemisphere.

M. MARCHIONE: All right. Do we know anything about the source of the animals beyond Illinois?

DR. HUGHES: Not at this time. As I mentioned, the trace-back investigations are in progress.

M. MARCHIONE: All right. Thank you very much.

DR. HUGHES: Thank you.

MODERATOR: The next question comes from the line of Melissa Gray with CNN. Please go ahead.

M. GRAY: My question is about tracing the animals as far as the Illinois distributor, if you could just go over that one more time and explain what you know about where the animals came from?

D. RUTZ: Let me ask Dr. Dworkin, who is on the line, if he is in a position to comment more on the Illinois aspect of the investigation.

Dr. Whitaker … can comment on.

D. RUTZ: Dr. Whitaker?

DR. WHITAKER: Yes. In terms of, as I think was mentioned earlier, there were two different species of animals at the pet store in Illinois that were of concern, one, the prairie dogs and secondly, the Gambian rat.

Presently we don’t have good evidence on what the source of the Gambian rats are. In terms of the prairie dogs, that investigation is ongoing, but at this early state they appear to be purchased from two different states, one in Texas and secondly in South Dakota.

M. GRAY: That’s the prairie dogs?

DR. WHITAKER: That’s correct. And again, this is evolving. The complicating factor with how these animals end up in one place or another is not only can they be purchased, but individuals also swap them informally at swap meets.

DR. HUGHES: Do you have a follow-up?

M. GRAY: No. That’s all. Thank you.

DR. HUGHES: Next, please.

MODERATOR: Your next question comes from the line of Tom Spalding with The Indianapolis Star. Please go ahead.

T. SPALDING: Can you guys break down the locations, in particular, 13 in Wisconsin, two in Illinois and one in Indiana, particularly in Indiana, and how that person got in contact with this dog? Was it a swap meet or was it some other type of pet store sale?

D. RUTZ: Dr. Teclaw, can you take that one, please? Or let me suggest Dr. Davis from Wisconsin could address the Wisconsin experience.

Dr. DAVIS: Thank you very much. This is Jeff Davis. I am Chief Medical Officer and State Epidemiologist for Communicable Diseases with the Wisconsin Division of Public Health.

I will basically delineate to you the cases that have been reported to us so
far in Wisconsin. I will delineate them to you regarding the category of exposure, in other words, the means by which people were exposed to ill animals. Our current estimate of cases in Wisconsin, as of right now, is 17 cases. These are individuals who reside in four different counties in the state. Basically we have cases in two different regions of the state. In the northwestern part of the state a total of four and the rest are in the southeastern part of the state.

Our best means of characterizing these would be the following: We have … cases in one household that involve the distributor of prairie dogs. We have three members of another household who purchased prairie dogs at a swap meet, which occurred in Wausau, Wisconsin, in early May. A swap meet is basically you can purchase an animal or trade an animal and acquire one.

We have three cases that involve two households. We have one member in each of those households and those were households that purchased prairie dogs from pet stores, and we have an individual who was a painter at one of those homes that had animal exposure.

We also have, we think, six cases of illness among either veterinarians or veterinary technicians in three different veterinary clinics in three different counties, all of whom took care of ill prairie dogs.

Then we have two cases, one case among staff of each of two pet stores in southeastern Wisconsin that purchased prairie dogs from the Wisconsin distributor. Also, the prairie dogs at the swap meet were also provided by the Wisconsin distributor.

In addition, we have a human case in a household where the exposure was to a rabbit. The rabbit was an animal that was also being managed in a veterinary clinic at the same time as that clinic was managing an ill prairie dog. The rabbit became ill and developed a similar illness to the prairie dog. That rabbit died spontaneously, but the owner of that rabbit became ill with a characteristic illness.

So far, of our 17 cases, 16 have had rash and one, who has not yet developed a rash, had onset, very recently, on June 3rd. Our earliest case onset was May 15th and our most recent case onset has been June 3rd.

T. SPALDING: To clarify, you said 17 cases just in Wisconsin?

DR. TECLAW: That’s just in Wisconsin, right. That’s as of right now.

T. SPALDING: Is that 17 illnesses or just 17 …

DR. TECLAW: We have to count everything as suspect cases. Many of these are based on their clinical histories, very important clinical findings. The prodrome is the fever, the chills, the aches, muscle aches, headache and also fairly profuse sweats, and that’s followed several days to up to ten days or so later by the rash illness, and Dr. Hughes described the progression of the rash. About a third of our patients have had a non-productive cough as part of their prodrome.

D. RUTZ: Do you have a follow-up question, please?

T. SPALDING: Yes, the Illinois and Indiana exposures and cases please, more information on those.

DR. WHITAKER: I am currently only aware of one case that’s been confirmed for the monkey-like pox in Illinois and that was an employee who worked at the pet store itself.

D. RUTZ: Thank you. David, next question, please.

MODERATOR: The next question comes from the line of Betsy McKay with The Wall Street Journal.

B. MCKAY: Thank you very much. Just a couple of questions: I wanted to clarify, among these cases, were any of them human-to-human transmission? Beyond that, what do you know about human-to-human transmission? How is it transmitted in cases that have been noted in Africa?

The second question is how is it being treated? Thank you.

D. RUTZ: Dr. Hughes?

DR. HUGHES: Betsy, let me speak to the bit of background about what’s known about transmission in Africa and then we’ll let Dr. Davis comment on circumstances of any possible human-to-human transmission that he’s been investigating.

In Africa the disease appears to be associated primarily with contact with rodents. It can spread within households and reported household attack rates are less than 10%. You have to realize that these outbreaks have occurred in very remote settings, where very thorough epidemiologic investigations are very difficult to do, so it really is not clear to me exactly how transmission occurs in those household settings.

D. RUTZ: Dr. Davis?

DR. DAVIS: Thank you. Based on information that we have received from clinicians in a variety of settings, but certainly in Marshfield and in Milwaukee and from public health agencies involved with the investigation in the northwestern and the southeastern part of the state and our staff, our best data would suggest that 16 of 17 cases clearly had their exposure as a result of animal exposure.

The 17th case involves animal exposure as well, but we can’t exclude transmission from a human because in that situation it involved a mother who had been taking very close care of an ill child and had to administer direct care. There was contact with secretions and there were also opportunities for the organism to get into, break through the skin. But, everyone in that household was exposed to an ill prairie dog and there were certainly ample opportunities, independent of any human contact, for that individual to have been exposed only to the prairie dog.

So we feel as though in all 17 cases there was either direct or very close contact with an ill animal; 16 of them about involved prairie dogs and one involved an ill rabbit.

Thank you, Jeff. A follow-up, quickly?

B. McKAY: Yes. I also wanted to ask about how this disease is being treated.

DR. HUGHES: Let me suggest that we let Dr. Peter Jahrling from USAMRIID comment on approaches to therapy.

DR. JAHRLING: Thank you, Dr. Hughes.

We are doing some experimental infections of monkeys with Monkeypox here, with an idea to developing effective treatment strategies. We have good data from cell culture studies that suggest that Monkeypox virus is susceptible to the drug Cidofovir and we have done some preliminary animal modeling studies, which indicate that within two days of exposure to the virus, otherwise lethally infected primates will be spared the consequences of infection. They will become infected and they’ll become clinically ill, but they will not die.

Now, I have to caution that this is a very artificial animal model in which the monkeys are exposed to overwhelming doses of Monkeypox virus by the intravenous route. What this does is it essentially eliminates the entire incubation and prodrome of the disease and we give the animals an artificial viremia. So they are essentially the same as people would be, perhaps a week to ten days into the infection.

However, at the time that we intervene with the Cidofovir they still have not broken with the clinical rash that’s so distinctive for Monkeypox virus, although the animals are clinical ill, they’re febrile and some of their hematology parameters would indicate that they are infected with viruses and presumably they feel ill. So we have not pushed this out any further and cannot tell you how late in the disease course Cidofovir is effective, but clearly, the drug has some beneficial effect and might be seriously considered in a treatment regimen, but that’s for others to decide.

D. RUTZ: Thank you, Dr. Jahrling. Next question, please.

MODERATOR: Our next question comes from the line of Daniel Yee with The Associated Press. Please go ahead.

D. YEE: Thanks for doing this. I was wondering if there are any measures right now being done to control the sale or trade of these prairie dogs or Gambian rats? I was also kind of wondering when and how CDC or the public health system was alerted to this?

DR. HUGHES: This is Dr. Hughes at CDC. We got notification of this, I believe it was this past Wednesday, of the situation and have been working with state and local authorities and clinicians and the U.S. Department of Agriculture to investigate this problem since that time.

I’m sorry, the other part of your question was?

D. YEE: I was just wondering if there’s anything being done to control the sale or trade of these prairie dogs or Gambian rats from these affected states?

DR. HUGHES: Yes. Dr. Davis, I know, can comment on that from the Wisconsin perspective.

DR. DAVIS: Thank you very much. Yesterday I signed an emergency order of the Wisconsin Department of Health and Family Services in order to protect the health of our citizens under the authority that’s granted under our Wisconsin statutes. Under this emergency order the Department of Health and Family Services in Wisconsin is prohibiting the following: There are three different things that are being prohibited with regard to prairie dogs that are received after April 1, 2003.

We are prohibiting the importation; that’s one. We are prohibiting the sale or distribution and prohibiting the display or any activity that would result in direct human contact from these prairie dogs.

These prohibitions also apply to any other species of mammal that has come into contact with prairie dogs received since April 1, 2003. Clearly, once the scope of precisely which mammals can be infected by this Monkeypox-like virus is fully delineated and certainly, the best knowledge is that animals that are susceptible include the rodents and lagomorphs, which are rabbits or hares, and non-human primates. (background noise)… of animals don’t seem to be infected, but you can ask people with more knowledge about that than I for that risk.

These prohibitions will remain in effect until the role of prairie dogs in the transmission of this disease is clear and the department has concluded there is no longer a risk to humans from contact with prairie dogs, although we do not feel that prairie dogs are pets that are suitable in a household, given the potential of transmission of unusual infections, such as has occurred in this situation.

D. RUTZ: Daniel, do you have a follow-up?

DR. WHITAKER: May I comment? This is Deric Whitaker from …

D. YEE: Can I jump in for a second?

Dr. Whitaker

D. YEE: Sorry. I was just wondering, as a follow-up, how many animals have been destroyed? Have there been any prairie dogs destroyed at this point?

D. RUTZ: Are you asking any one person that question?

D. YEE: I guess overall, if possible.

DR. DAVIS: We have Bob Ehlenfeldt, who is our state veterinarian, and he can provide information on that. I am going to turn it over to Bob.

DR. EHLENFELDT: To my knowledge we have had our veterinarians euthanize seven prairie dogs at one pet store in Milwaukee. Six of those prairie dogs had clinical symptoms and the seventh one was exposed. Samples from those animals are en route to CDC.

There were a number of prairie dogs that have died and there are some that have or are in the process of recovering as well.

D. RUTZ: Dr. Whitaker?

DR. WHITAKER: Yes. I was just going to comment that our legal counsel in the Department of Public Health, in conjunction with Governor Blagojevich’s office, their legal counsel, we are in the process of exploring our options. I could do things at my level at the public health department, but we’re exploring, from the level of the Governor, of doing things similar to what has been done in Wisconsin.

In addition, we are looking at expanding the ability of the state government to take control of the animals, if necessary, to again do sampling and/or euthanizing them. We’ll have additional information and that maybe has gone on since I’ve been on this call.

D. RUTZ: Thank you. Next question, please.

MODERATOR: The next question comes from the line of Gayle Worland with The Chicago Tribune. Please go ahead.

G. WORLAND: Thank you all, again. Can you please clarify the status of these patients? Have they all been hospitalized? Can you give us an idea of the range of ages of those affected?

D. RUTZ: Dr. Davis?

DR. DAVIS: Thank you. Yes, we can provide that information for you right now. A total of four individuals in Wisconsin have been hospitalized and three remain hospitalized.

In terms of the range in ages of our case patients, the youngest is four. The oldest is 48.

D. RUTZ: Gayle, do you have a follow-up?

G. WORLAND: I do. I don’t quite understand the role of the Gambian rats in this. Do you believe that they are the source of transmission of this, of importation of this disease?

That’s certainly one of the leading hypothesis at this point. Realize that this has been an investigation that is very early and has only in the last several hours really focused in on Monkeypox. There is evidence from studies that have been done around outbreaks in Central and West Africa in the past to suggest that Gambian rats, present in those environments, have a sero-prevalence of antibodies to Monkeypox virus on the order of approximately 15%, but this is based on one study of a small number of animals. So it is certainly possible that one of these Gambian rats was the original source of this virus, but stay tuned.

D. RUTZ: Folks, it’s 5:45, 4:45 central. We are going to go another 15 minutes. Next question, please.

MODERATOR: The next question comes from the line of Todd Richmond with The Associated Press. Please go ahead.

T. RICHMOND: I have three questions, actually. The numbers of cases I am a little confused about. At the beginning of the press conference you said there was 16 total in the Midwest, but Wisconsin has 17? Can someone please clarify how many cases there are?

DR. HUGHES: I am going to call on each of my colleagues from the three states to update these. You realize this is an investigation occurring in real time, so the numbers that I gave you were my understanding from a little earlier today, and obviously some of the numbers have changed. In Wisconsin, Dr. Davis, you had indicated a total of 17 cases now, right?

DR. DAVIS: Yes. That’s correct, Jim. At the beginning when Dr. Hughes gave the overview the number 13 was used and that certainly was the number that was current until late last evening, and then we learned of additional cases, and based on the information that we’ve received, those certainly are strong cases and are every bit as strong in terms of their clinical characteristics and in terms of definition that they should be included. That resulted in our having 17 at the time of this telebriefing.

D. RUTZ: Dr. Whitaker?

DR. WHITAKER: I know of one confirmed case and I must apologize at the … I only talk about confirmed things. I understand there may be a second case, but we have not moved that into our definition as yet.

D. RUTZ: And anyone from Indiana? Is Dr. Teclaw there, please?

Since no one from Indiana is available, we are aware, at CDC, of one reported case from Indiana now. It’s possible that that could have changed, but as of this moment we are aware of one in Indiana.

T. RICHMOND: Where is the Illinois distribution point? Where is it located?

DR. HUGHES: It’s located in Villa Park.

D. RUTZ: Next question, please.

MODERATOR: The next question comes from the line of Courtney Wade with The Chicago Sun Times. Please go ahead.

c. WADE: I just want to thank you again for taking the time to brief the media. Are there any long-term effects of Monkeypox aside from death? If death does not occur as a result what are the long-term effects?

DR. HUGHES: That’s a good question and I think it would be fair to say that we are not aware of any, but again, remember where the human experience with Monkeypox virus is in these remote areas of Central and West Africa, where there is certainly limited ability to evaluate patients when they are acutely ill, let alone follow them up, but we are not aware of any evidence of chronic manifestation.

C. WADE: How long have scientists and doctors been studying the Monkeypox-like virus in Africa? How long have you been aware of it?

DR. HUGHES: Let me ask Dr. Jahrling, actually, who has worked on the virus there, if he would like to take that one?

DR. JAHRLING: Yes. I think I can say, with some certainty, that Monkeypox became an entity that was recognized as something distinct from Smallpox during the waning days of global eradication in Africa, and I believe the first published papers on its existence were from Dr. Aurita’s lab in 1971. So I think our historical knowledge goes back to 1971.

D. RUTZ: Courtney, do you have anything else to follow up quickly?

C. WADE: Yes. What is the risk once you’ve been exposed? It is almost certain that you will develop this virus or is the chance waning?

DR. HUGHES: I can’t address that. I would imagine that it’s like any other infectious disease; that it depends in part on proximity of the exposure and the infectious dose and your immunological status. It’s certainly nowhere near as contagious as Smallpox. We can say that for certain.

D. RUTZ: Thanks, Courtney. Next question, please.

MODERATOR: Pardon me. Dr. Teclaw has joined the call as a speaker at the present time.

We have the next question. It will come from the line Robert Bazell, NBC News.

R. BAZELL: Can you tell me if any of the teams in either the CDC or the State Health Department that were designated as responders for Smallpox have been involved in this investigation? That’s part one.

Part two is because of the similarity of Smallpox, were these patients, when they were hospitalized, put into isolation?

Question number three is what in the world is a Gambian rat?

That’s it.

DR. HUGHES: Bob, thanks for the questions. In terms of the Gambian rat, if you go on Google and do a search you will see some photographs of Gambian rats.

R. BAZELL: Are they from Gambia or is there a species of rat in the United States?

DR. HUGHES: No. These are not indigenous to the United States. They are inhabitants of a number of Central and West African countries. There may be variants of them. I am certainly not an expert on them, but if you go on to the Web you can see the pictures of them.

I can speak in terms of what CDC has done since we heard about this the other day. We have sent teams of two people to work with Dr. Davis and colleagues in Wisconsin and a team of two to work with Dr. Whitaker and Dr. Dworkin and colleagues in Illinois. At least one of those individuals, I know, is involved in the Smallpox Emergency Response and that’s Dr. Joanne Cono, who is here in the room.

The other question?

R. BAZELL: One was have the patients who have been hospitalized been put into isolation and another that I meant to ask: doesn’t Vaccinia protect against Smallpox?

DR. HUGHES: In terms of Vaccinia, Smallpox vaccine protecting against Monkeypox, there is that …

R. BAZELL: Excuse me, against Monkeypox. I’m sorry.

DR. HUGHES: In endemic areas where Monkeypox occurs and in Central Africa there is evidence that the Smallpox vaccination is protective.

In terms of isolation, since most of the patients are in Wisconsin, let me ask Dr. Davis and his colleagues in Wisconsin to comment on that.

DR. DAVIS: Thank you very much. Yes, indeed, there was a recommendation for respiratory precautions for patients that were hospitalized, and until we knew more about what was occurring, and certainly until we had a better sense of what the etiology was, once it was clear that an orthopox virus may be involved, the infection control precautions generally were upgraded to protect against miracella, so they were pretty high-grade precautions. Certainly that includes the airborne precautions. In addition, of course, there were contact precautions and it’s certainly very important to stress the good hand hygiene.

If anyone else wishes to talk about that from any of the hospitals or from … in Milwaukee, of course, you can ask the question further.

DR. MELSKI: This is Dr. John Melski from the Marshfield Clinic. In our patients who were hospitalized prior to the identification of the virus, these patients, the one patient and the family, were just in contact precaution. We did not suspect any respiratory transmission, but there were no respiratory symptoms among any of our patients. They are currently out of the hospital and they are also at home and they have not resumed going back to work.

Thank you. Before going to the next uestion I would like to ask Dr. Teclaw, who joined us from Indiana, to quickly bring us up to date on the status of the situation there. How many cases, Dr. Teclaw?

DR. TECLAW: Yes, thank you. I was on the call all along. When I would speak nothing happened.

Indiana has one case, which we learned about yesterday evening. The person is an adult and is hospitalized and is isolated.

D. RUTZ: Thank you. Next question, please.

MODERATOR: The next question comes from the line of Marilynn Marchione with The Milwaukee Journal. Please go ahead.

M. MARCHIONE: Thanks very much for coming back to me. I have two questions. One is for Dr. Jahrling. If you could please tell us, Doctor, your involvement with Monkeypox, I assume, preceded this outbreak and was not in response to this outbreak, but I’d like you to clarify that. Were you called in on this because there was concern that an orthopox virus raises questions or concerns about bioterrorism?

My second question is has this virus ever been seen in human outbreaks outside of Africa?

DR. JAHRLING:  Thank you for the question. I was brought in here simply because of my long-term association with our colleagues at CDC, who were working with, hand in glove, to develop effective antivirals against Smallpox and related viruses, which would include Monkeypox.

We actually began investigating both the efficacy of vaccines. There was a question earlier about whether the vaccine would protect against Monkeypox and, in fact, we demonstrated that the available vaccine does protect against Monkeypox in the Monkeypox challenge model.

We’ve also been investigating a number of antiviral drugs and testing them for efficacy in the model and it was because of our experience with the animal models and experience with putting this virus into rodents and what have you that I was asked to participate, simply because of my hands-on experience, which goes back to 1995.

M. MARCHIONE: And again, was there any concern or thoughts on any of your parts that this could have been a bioterrorism concern?

DR. JAHRLING: I guess that’s always something we need to consider these days, but certainly, from what I have heard - and I just became aware of this myself about 2:00 this afternoon - it seems to me the epidemiology is pretty tight. The association with prairie dogs seems pretty convincing to me. So yes, we have to be aware of that contingency, but I think it’s remote.

M. MARCHIONE: Also, have there been any outbreaks outside of Africa?

DR. JAHRLING: Not that I am aware of.

M. MARCHIONE: Thank you.

DR. HUGHES: Marilynn, on the bioterrorism question, I agree with Dr. Jahrling. We never say never. We always keep an open mind but there is nothing so far that would suggest that this has any nefarious side to it.

DR. MELSKI: I would point out that some of the patients, including one of ours, is of an age that they did receive the Smallpox vaccination, but obviously it was not protective over that many years.

D. RUTZ: Thank you. We have time for one last question.

MODERATOR: The last question will come from the line of Melissa Gray with CNN. Please go ahead.

M. GRAY: I was wondering if there had been any outbreaks like this in the United States. I know Dr. Jahrling just said there were no outbreaks that he knows of of Monkeypox outside of Africa, but any similar outbreaks with prairie dogs in the United States?

DR. HUGHES: We are not aware of this virus causing community-acquired disease in even animals or in people in the United States or elsewhere in the Western Hemisphere.

M. GRAY: My other question was how do you spell Cidofovir?

DR. HUGHES: We’ll let Dr. Jahrling have …

DR. JAHRLING: I’ll take that one. It’s c-i-d-o-d-o-f-o-v-i-r.

DR. HUGHES: Try that again.

DR. JAHRLING: Wait. I want to write that out; c-i-d-o-f-o-v-i-r.

M. GRAY: Thank you.

DR. JAHRLING: You’re welcome.

D. RUTZ: Thank you all for taking part in this telebriefing, a transcript of which will be on the CDC Web site within an hour or so. We thank you for being with us.

MODERATOR: Ladies and gentlemen, that does conclude our conference for today. Thank you for your participation and for using the AT&T Executive Teleconference Service. You may now disconnect.

Listen to the telebriefing

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