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Monkeypox: ‘This is an entirely new spread of the disease’

Via The Conversation

One thousand confirmed cases of monkeypox, a disease originating in Africa, have been recorded since early May across at least 30 non-endemic countries such as the United Kingdom, Spain, Portugal, France, the United States, Australia, United Arab Emirates and Israel. But what is this virus? Who is affected? And should we be worried about the recent surge in cases?

In a bid to answer such questions, we caught up with Camille Besombes, a medical doctor specialist in infectious diseases, who has been involved for the past three years in Afripox, a project that aims to gain a better understanding of the virus in its endemic region. She is currently conducting PhD research within the unit headed by the project’s coordinator, Arnaud Fontanet, a leading medical epidemiologist and emerging infectious disease specialist at the Pasteur Institute.

The Conversation: What exactly is the monkeypox virus?

Camille Besombes: Monkeypox is a virus belonging to the genus Orthopoxvirus, a family that also includes smallpox. Like smallpox, it is a large DNA virus with a particular appetite for skin tissue. However, smallpox only affected humans, which meant that we were able to eradicate it through worldwide mass vaccination, whereas monkeypox is carried by an animal viral reservoir. And despite its name, the natural reservoir is not actually monkeys.

The term “monkeypox” was coined when the virus was first identified in captive primates (in Denmark back in 1958), but in nature, the virus is most often found in squirrels and other rodents. In 1970, the first human case of monkeypox was documented in a nine-month-old child in the Democratic Republic of the Congo, amid increasing efforts in the campaign to eradicate smallpox.

There are two strains of monkeypox that we know of. The type that affects Nigeria, Liberia, Sierra Leone, and Côte d’Ivoire is the so-called West African strain, with a case-fatality rate between 1 to 3%. This is the one that was detected in the recent cases in Europe. The second is the “Congo Basin” strain, which circulates in the Democratic Republic of the Congo (DRC), the Republic of the Congo, the Central African Republic (CAR), and Gabon. Both strains are now circulating in Cameroon: recently, cases of infections implying the West African strain – imported from Nigeria – have been reported. Associated with more severe clinical forms, the Congo Basin strain has a case-fatality rate of around 10%.

We must also keep in mind that these figures are taken from countries where medical care is somewhat lacking, particularly in more remote regions. As for Europe, several patients are currently in hospital with the disease, but no death and no severe form of it have been detected on the continent.

Diagnosis of monkeypox:

What are the symptoms of this disease?

CB: Following a relatively long incubation (usually lasting around 6 to 13 days, and up to 21 days), it presents its first onset symptoms during a two-day period known as the “prodromal” phase. These symptoms may include high fever, headaches, swollen lymph nodes (which are a sign that distinguishes it from smallpox), muscle pain, and fatigue. It is at this stage that patients are considered to be contagious.

Next, the patient develops a rash, usually starting on the face and gradually spreading over the rest of the body. This rash causes pain and intense itching due to the inflammation that occurs around the skin lesions. In the West African strain, these lesions can be initially rather infrequent and discreet, and may therefore go unnoticed. The disease typically lasts two to four weeks and tends to go away spontaneously in the majority of cases.

The main complications of monkeypox include dehydration due to water loss from numerous and more widespread lesions, secondary bacterial infection of the lesions, sepsis, and corneal or other ocular lesions that may lead to vision loss. On top of these, cases of encephalitis (ed. note: “inflammation of the brain”) have also been documented, most notably in a child during the 2003 US outbreak.

Children who have been infected with monkeypox are more likely to experience complications and therefore have a higher fatality rate than adults. It is also assumed that immunocompromised individuals (particularly those who are HIV-positive) have a higher risk of developing a severe form of the disease, but there is not enough data yet to know this for certain. During the 2017-18 Nigerian outbreak, four out of seven people who died from the disease were HIV-positive. Pregnant women could also be affected by less moderate forms and we noted instances of mother-to-child transmission.

Treatment for monkeypox

Treatmentof the disease is largely symptom-based and involves methods like disinfecting the lesions, administering antibiotics in cases of secondary infection, and rehydration. Research is currently being conducted into whether certain antiviral molecules (such as tecovirimat could be effective against monkeypox, but the results are not yet conclusive.

History of monkeypox:

Is this the first time that the virus has spread outside of the African continent? How many cases have been recorded so far, and where?

CB: No, it isn’t the first time. Although the Congo Basin strain has never travelled beyond Africa, the West African strain managed to reach the United States in 2003 by way of imported animals that had been infected. More recently, however, a number of countries have reported several cases brought in by humans.

Back in 2003, number of individuals in the United States caught the virus from infected prairie dogs purchased from pet shops where the animals had been in contact with monkeypox-carrying Gambian pouched rats (Cricetomys gambianus) imported from Ghana. A total of 47 suspected cases of human infection were recorded, all the result of zoonotic (i.e., animal-to-human) transmission. There were no instances of interhuman transmission. At the time, the US authorities were concerned that the virus might take over a reservoir of local species, but this did not happen.

Then, in September 2017, a more severe outbreak occurred in Nigeria, which had not experienced any monkeypox epidemic in the preceding 39 years. This particular epidemic is still ongoing, sustained by sporadic, regular transmissions that are both zoonotic and interhuman. To date, at least 500 suspected cases have been declared (215 of which have been confirmed). Reassuringly, albeit regrettably, only 8 deaths have been documented in the past 5 years.

However, the Nigerian epidemic had marked a major change in monkeypox epidemiology and should have acted as a warning to us. Whereas the virus had tended to thrive in forest regions with little connection, in 2017, it hit the country’s more urban areas and at a larger scale. This is how it managed to spread more easily beyond the continent, with cases popping up in 2018 in Singapore, Israel, and England, brought back by travellers returning from Nigeria.

In the case of England, a local human-to-human transmission occurred when a British healthcare worker became infected while cleaning a patient’s bed. There was no endemic viral circulation at the time, but more infections emerged in 2021, again linked to travellers coming back from Nigeria and occurring both in the UK and in the United States (where two cases were recorded).

In the UK in 2018, scientists also studied the risk of emergence of an endemic animal reservoir. Species such as the common squirrel (Sciurus vulgaris) and domestic mouse (Mus musculus) were thought to be particularly prone to the virus, while other rodents (voles, dormice, other mice) or still hedgehogs were also considered as potential reservoirs.

Monkeypox Origin: First Case of Monkeypox This Time

What is different about the current context?

CB: The situation is very different this time around. We know that the first case of the current epidemic, recorded on 7 May in the UK, was that of an individual travelling back from Nigeria. However, several other UK cases have since been confirmed that are apparently unrelated to one another or to this 7th May case. No instance of foreign travel (to African countries) associated with the infections has yet been proven and the direct chains of transmission have not been identified, suggesting the existence of several chains of transmission and a local circulation of the virus.

As of 6th June, 1,000 cases had been detected in at least 30 different countries, worldwide, with the largest number of cases located in the United Kingdom (287 confirmed), Spain (189 confirmed), Portugal (143 confirmed). French authorities have reported 51 confirmed cases. For now, all of the recorded infections outside of Africa have been mild. Only a few patients have been hospitalised and no death or vital threat has been reported. A non-negligible proportion of cases were reported among HIV+ patients.

That said, these local circulations of the disease are unprecedented. Another new aspect is that the cases have almost exclusively been reported among young males, primarily among homosexual men (in the UK, the authorities emphasised that “currently most cases have been in men who are gay, bisexual or have sex with men”). Only six suspected and confirmed women were declared in Spain, Czech Republic, Italy, the United States and United Arab Emirates. These last two women were not linked to the European cluster following mass gathering events, but returned from Western Africa, suggesting something is up with the Nigerian epidemic that is exporting the virus.

What are the usual channels of infection?

Why is this new?

CB: Monkeypox epidemics most often arise from animal-to-human transmission, although the exact details of how they occur are unclear and it has not yet been possible to isolate the same viral strain in animals and in humans. It may come from direct contact with a living animal when hunting or eating bush meat.

One thing we have noticed from our research in the CAR is that the outbreaks tend to be seasonal. This would suggest a link with certain seasonal activities like the harvesting of edible caterpillars, which involves individuals entering the forest, where they would be more exposed to local wildlife.

Even though scientists have been tracking the viral reservoir since the 1970s, it has, as of yet, only rarely been isolated in wild animals. The first instance was in 1985 in the DRC and involved a species known as a Thomas’s rope squirrel (Funisciurus anerythrus), thought to be the reservoir of the virus. The next was that of a sooty mangabey monkey in 1992 (Cercocebus atys) in Côte d’Ivoire. Then, two decades later, the virus was isolated in a Gambian pouched rat and another rodent species (Stochomys longicaudatus), as well as in another rope squirrel (Funisciurus _bayonii) and a shrew (Corcidura litoralis). As things stand, the prime suspects for the viral reservoir are rodents, including squirrels.

Interestingly, monkeypox was also found in chimpanzee feces in Taï National Park, Côte d’Ivoire, during an outbreak among primates, which implies the possibility of environmental contamination.

Aside from zoonotic transmission, there’s also human-to-human transmission, which occurs as a result of direct and prolonged contact with infected individuals through exposure to bodily fluids or contaminated materials (e.g. clothing, bedding, or surfaces). Such infections most often take place within the home.

Transmission through inhalation of respiratory droplets has also been considered, but this point is difficult to ascertain. Generally speaking, infections take place within the family home, where there is closer human proximity and modes of contact are numerous and diverse. Africa has also seen some cases of hospital-acquired infection.

In a detailed case description of the 2017 Nigerian outbreak, a large proportion of individuals suffered genital infections (68%), suggesting for the first time that the virus could be transmitted through close skin-to-skin contact during sex. Our data also shows that the rate of such infections is very high among cases recorded in the CAR.

Close, intimate contact during intercourse may be behind the new increased frequency in interhuman transmission of monkeypox, a virus that is usually thought to present low transmissibility. This theory is supported by the fact that – at the time of writing – the “non-African” cases of recent weeks have mainly affected young men who have sex with men or who identify as homosexual. It should be noted, though, that such transmissions could also occur during heterosexual intercourse.

Italian researchers have recently detected significant amount of monkeypox virus in the semen of 3 patients. However, the authors stressed that these findings “cannot be considered definitive evidence of infectivity”. The implications for transmission are not clear either.

Monkeypox in humans:

Should we be worried about this disease becoming widespread?

What can we do to prevent this?

CB: For now, we can’t say for certain what will happen. The problem is that the chain of transmission of these new cases has yet to be identified. As indicated by the daily evolution of the virus, and due to its relatively long incubation period, there is a real risk that new infections could emerge within the coming days and weeks, whether in countries that are already affected or elsewhere.

Numerous cases in Spain and Europa appear to be linked to two festivals, one in Belgium between 4 and 9 May and one that took place in the Canary Islands between 5 and 15 May. The latter was attended by 80,000 people, potentially making it a “super-spreading” event.

In order to prevent the spread of the virus, we need to raise awareness among the communities and individuals concerned, and among doctors, so that we can quickly identify each case and trace their contacts.

One difficulty facing doctors is that monkeypox lesions resemble those caused by chickenpox and, when they occur on the genitals, they can be mistaken for symptoms of some STIs (like syphilis and herpes). A monkeypox diagnosis can be confirmed by a PCR test and isolation of the virus, but only a few specialist laboratories are equipped for these types of analysis.

Nevertheless, we can find some reassurance in the fact that monkeypox outbreaks resolve spontaneously and relatively quickly. The longest chain of transmission ever identified was carried over seven generations, meaning that seven humans passed on the disease consecutively before transmission ceased.

It is unclear why spreads simply stop like this. One hypothesis is that, until recently, these outbreaks would occur in small villages within restricted communities where some individuals might have already been immune, so the virus would contaminate only those who had never been in contact with it. But the 2003 epidemic in the United States also ended quickly and without any secondary human-to-human infection.

It remains to be seen where this new outbreak will take us.

Could the smallpox vaccine protect against this virus?

CB: We know that a natural infection of smallpox offers cross-protection against monkeypox. In the 1980s, it was shown that the smallpox vaccine could also provide cross-protection at a rate of around 85%. However, these estimates were made just a few years after the mass-vaccination campaign to eradicate smallpox. It is now believed that its efficacy is closer to around 63% against severe disease.

Moreover, smallpox vaccination was suspended in the 1980s once the disease was wiped out. Today, only a handful of healthcare professionals are vaccinated (in case of bioterrorist threats, while the virus is stored under high surveillance at a number of laboratories) and the first generation of the vaccine is no longer used, due to significant side effects.

Monkeypox Vaccine:

At present, if ever necessary, the most suitable vaccine for a roll-out would be the “third-generation” version known as Imvamune (or Imvanex or Jynneos).

This is an attenuated vaccine that can be administered to immunocompromised people, unlike older vaccines. It has already been given to healthcare professionals and contact cases in Israel, Singapore, and the UK, and its effectiveness is currently being assessed among healthcare professionals in the DRC.

There are also a number of fourth-generation “subunit” vaccines in development. These do not contain the attenuated virus and instead have only fragments of it. They are also being assessed for their effectiveness.

Vaccines can be administered as either a pre-exposure (i.e., before contact with the virus) or a post-exposure treatment. With regards to the latter, US guidelines recommend that it be given preferably within 4 days and up to 14 days after exposure. On 27 May two French individuals received post-exposure vaccination for the first time after a high-risk contact with confirmed cases.

Could we see other variants of monkeypox emerging?

Is the genome of the virus currently circulating in Europe identical to the West African strain?

CB: Monkeypox is a DNA virus, which means that it is less likely to mutate than an RNA virus like SARS-CoV-2.

It is actually quite simple to determine whether we are dealing with a West African or Congo Basin strain. We just need to sequence out short sections of its DNA. But given the large size of the viral genome, it takes time and effort to obtain a complete sequence. We need this complete sequence in order to detect differences in sequences more precisely, which would allow us to identify chains of transmission and find out how cases are linked. However, if our experience with SARS-CoV-2 has taught us anything, it’s that a large-scale global effort can be of great help in moving things along.

Initial sequencing carried out on samples from a Portuguese and a Belgian patient have shown the genetic proximity of the virus to strains isolated in Nigeria and during the previous out-of-African spread of the virus in 2018, with genomes of the ongoing outbreak being highly similar. This is in favour of a single introduction followed by community spread in Western countries after superspreading events.

More detailed genomic analyses comparing 2022 strains to those of 2018 identified around 40 mutations (fivefold the expected rate of mutations) with a pattern specific of the action of an antiviral enzyme called APOBEC which may reveal the sustained circulation of the virus in a new animal intermediate host, or in humans. This observation, possibly indicating a recent increase in viral circulation in Nigeria, matches the documentation of cases in peri-urban areas of Nigeria like Abuja, together with increased frequencies of overseas exportation of cases.

A recent article hypothesises that Nigerian synanthropic rodent populations (i.e., undomesticated rodents that live in close association with people and benefits from their surroundings) have increased in recent years as a result of land conversion and high urbanisation leading to increased human-rodent contact.

Further sequencing is required to address remaining questions, like genome adaptation toward increased viral transmissibility. But, for the time being, there has been no evidence to suggest this.

In a more exceptional way, what looks like a relapse of the monkeypox disease was reported among one of the 2018 UK patients, with an increased lymphadenopathy, a recurrence of rash and a transient shedding of monkeypox viral DNA following initial complete recovery. This hypothesis requires further study to be exploited.

In 2019, the Institut Pasteur came together with partners in France and the CAR to launch the Afripox project, driven by a goal to increase understanding of the monkeypox virus and its spread. What exactly does the project involve?

CB: Afripox is a cross-disciplinary project that was set up in light of an increasing number of monkeypox outbreaks in the CAR, as reported by Emmanuel Yandoko Nakoune, Director of the Laboratory for Arboviruses, Viral Haemorrhagic Fevers, Emerging Viruses, and Zoonoses at the Institut Pasteur in Bangui, the country’s capital.

In the past few decades, monkeypox outbreaks have been more numerous and frequent in Africa overall, with the disease also expanding into areas where it was not endemic before. Improved medical monitoring and reduced immunity (following the end of smallpox vaccinations in 1980) are likely to have contributed to this figure, but the phenomenon may also reflect a growing viral circulation in a region of the world currently experiencing major ecological disturbances.

Faced with the many uncertainties surrounding the epidemiology of monkeypox, the idea for this project was to rely on the CAR’s existing national medical monitoring system to develop a One Health approach toward the monkeypox virus, encompassing all its aspects in epidemiology, ecology, zoology, anthropology, and virology.

For instance, through our partnership with researchers from the French National Museum of Natural History, we are attempting to identify its animal reservoir. Meanwhile, along with the SESSTIM team in Marseille, we are exploring the disease’s ecology in order to better understand why it spreads more in forest areas, pinpoint how deforestation affects outbreaks, determine whether or not there is a seasonal aspect, and so on.

In the near future, the Afripox project also hopes to use on-the-ground PCR diagnostic tests that are currently being developed by the Emergency Biological Response Unit (“Cibu”) team at the Institut Pasteur in Paris. For now, suspected case samples are analysed in Bangui, but these tests would allow for reduced diagnosis time and quicker implementation of the appropriate measures.

Lastly, the epidemiological and anthropological aspects of the virus are being explored by the teams at the Institut Pasteur Paris (namely, the Emerging Diseases Epidemiology Unit and the Emerging Diseases Anthropology and Ecology Unit), in collaboration with local researchers. Their goal is to precisely determine the risk factors of zoonotic or interhuman transmission and ascertain why monkeypox has been on the rise since the 1980s.

While it is essential to identify the mechanics of this latest human-to-human epidemic of a relatively new format, it is also vital to understand how monkeypox emerges and circulates in its continent of origin.

When Afripox was launched three years ago, few could have imagined that this disease would one day spread beyond the African continent and across the planet. The current epidemic has highlighted once more the importance of investing in scientific research over the long term, so that we can be better prepared for any and all eventualities.

Translated from the French by Enda Boorman for Fast ForWord.

This article is republished from The Conversation under a Creative Commons license. Read the original article. Camille Besombes, Institut Pasteur and Arnaud Fontanet, Conservatoire national des arts et métiers (CNAM)

How monkeypox epidemic is likely to play out – in four graphs

Adam Kleczkowski, University of Strathclyde

The first case of monkeypox in a human was reported in 1970 in the Democratic Republic of the Congo. Since then, there have been many monkeypox outbreaks, but they have been self-limiting, with chains of human transmission ending without establishing epidemics. The current outbreak, however, is different. There is more human-to-human transmission, and it is over a much broader geographical area.

In mere weeks, monkeypox has spread to 37 non-endemic countries, with over 2,600 cases. So, what is likely to happen to monkeypox in the following weeks and months?

There are huge gaps in what we know about monkeypox, but combining what we do know with a history of other infectious diseases makes it possible to analyse likely future scenarios.

The four scenarios below are based on the following knowledge: the average number of people an infected person is likely to infect (assuming they have not been vaccinated against the virus or have had the disease before) is 2.13. This is called the basic reproduction number, or R. Herd immunity – the point at which enough people have immunity such that disease transmission can’t be sustained – is 53% (corresponding to this value of R). And the incubation period, the time from catching the virus to the appearance of symptoms, is between five and 21 days.

Scenario 1: Self-limiting outbreak

The 2022 epidemic appears to have started as a super-spreader event involving a network of predominantly men who have sex with men.

But until the current outbreak it was assumed that the relatively low human-to-human transmissibility of the virus makes it unlikely for the virus to spread outside the initial community.

In this scenario, the outbreak ends quickly once the population at risk becomes immune and herd immunity is reached locally. In the past, many people had some immunity (called “cross-immunity”) from the smallpox mass vaccination programmes of the late 20th century. So the effective reproduction number, R, can be close to or even lower than one, and the transmission will soon stop.

Behavioural changes can reduce the number R even more. For example, the ring vaccination can form a “firebreak”, further reducing the susceptible population. Similar previous epidemics include the Sars outbreak in 2002-04, when a quick intervention stopped the disease from spreading.

Scenario 2: All population

The continuing spread of monkeypox in May and June 2022 suggests that the virus is moving beyond the original network.

The size of the outbreak is already well beyond the most prominent 2017-19 outbreak in the Democratic Republic of Congo (760). It is possible that large gatherings, including raves and festivals, have created new transmission clusters.

Scenario 2 assumes that everybody below the age of 50 is susceptible to the infection, reflecting the end of compulsory smallpox vaccination in the 1970-80s. The virus will continue spreading, effectively searching for pockets of high-risk and non-immune communities.

Unless a combination of contact tracing and ring vaccination stops the spread, the monkeypox will continue spreading. But, given the low transmissibility of monkeypox, the epidemic may fizzle out before reaching the herd immunity threshold of 50% of the population.

Scenario 3: Becoming endemic

Complete eradication is impossible because monkeypox exists in a wide range of animal hosts. The low transmissibility also means it can survive at low levels in the population. In addition, the long incubation period and variable symptoms allow it to avoid detection. Therefore, monkeypox may have already been spreading for a long time.

In scenario 3, following the large outbreak, the disease will settle on a long-term, relatively constant level. Similar to the pre-vaccination smallpox or chickenpox.

The influx of susceptible people through birth or migration will keep the virus in the population. Mass vaccination programmes might be needed to eradicate the disease. But relatively low monkeypox transmissibility means such programmes are likely to be highly effective.

Scenario 4: Recurrent large epidemics

The current epidemic might be the first instance of a series of outbreaks. In the long term (scenario 4), we should expect a return of monkeypox caused by future “zoonotic events” where the disease jumps from animal hosts to humans. As the cross-immunity from smallpox vaccines wanes, the epidemics can become even more substantial.

Little is known about the potential of monkeypox to mutate. Still, there is potential for it to evolve into a more rapidly spreading variant.

Effective vaccines for monkeypox exist and are about 85% effective. Although there are currently not enough doses to vaccinate everyone, there is no need for a mass-vaccination programme given monkeypox’s low transmissibility. Instead, vaccines should be offered to those most at risk, including communities in Africa most in contact with the wild animals that carry the virus.

Adam Kleczkowski, Professor of Mathematics and Statistics, University of Strathclyde

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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(Reuters) -The U.S. Centers for Disease Control and Prevention (CDC) said there was evidence of local transmission of monkeypox, in addition to reports of cases where people had traveled abroad.

The cases are mainly occurring in men who have sex with men, but women are also getting infected, CDC staff member Dr. Agam Rao said at a panel meeting on Thursday.

Monkeypox, a viral infection that causes skin lesions, is endemic in certain parts of Africa. But the current outbreak has hit countries where the virus does not usually spread, sparking concern.

The CDC said had also been reports of transmission among family members and close contacts.

“We also heard worldwide about close contacts like close household members who through example shared bedding, towels, have acquired infection,” Rao said. “So it is not just through close intimate contact that this is being spread.”

The lesions associated with the present outbreak are also smaller than those typical of classic monkeypox, according to the public health agency.

The CDC last month published guidelines recommending the use of Bavarian Nordic’s Jynneos vaccine for laboratory personnel and other at-risk people, making another vaccine available in addition to Emergent BioSolutions’ ACAM2000.

Earlier on Thursday, New York City opened a temporary clinic to administer the two-dose Jynneos vaccine to eligible people who may have been exposed to monkeypox, including gay and bisexual men.

While there have been cases of heart inflammation called myocarditis associated with ACAM2000, no such cases have been reported yet after the use of Jynneos, the CDC said.

There is a limited supply of Jynneos and the agency is considering how to best use the supplies, it said.

(Reporting by Amruta Khandekar in Bengaluru; Editing by Aditya Soni)

WHO considers declaring monkeypox a global health emergency

The World Health Organization will convene its emergency committee Thursday to consider if the spiraling outbreak of monkeypox warrants a global emergency declaration. Meanwhile, some experts say WHO’s decision to act only after the disease spilled into the West could entrench the grotesque inequities that arose between rich and poor countries during the coronavirus pandemic. Declaring monkeypox a global emergency would mean the U.N. health agency considers the outbreak to be an “extraordinary event” and that the disease is at risk of spreading across even more borders. It would also give monk… Read More

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By Travis Gettys Kentucky’s current teacher of the year is leaving the classroom due to discrimination and lack of support because he is gay. Willie Carver Jr., the 2022 teacher of the year, is quitting teaching after 17 years to take a job at the University of Kentucky in student support services, and he will also be an academic advisor at the Gatton College for Business and Economics, reported the Lexington Herald-Leader. “This was not an easy decision; I have cried quite a few times trying to make it over the past few months,” Carver said in a Facebook post. “But, ultimately, I have always …

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ORLANDO, Fla. — At least six people in Florida have died in what the Centers for Disease Control and Prevention on Wednesday called “one of the worst outbreaks of meningococcal disease among gay and bisexual men in U.S. history,” with state and health officials and LGBTQ+ groups scrambling to alert the public about the deadly disease. As of Tuesday, the Florida Department of Health has recorded 10 deaths and 44 cases in 2022, more than double the annual average over the last five years: 13 of those were in Orange County, three in Seminole, three in Lake and one in Osceola. At least 26 of those…

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By Bonnie Stiernberg Pixar’s Lightyear, a Toy Story prequel that tells the origin story of Buzz Lightyear, has already been banned in 14 countries for a brief scene that includes a same-sex kiss between space ranger Alisha Hawthorne (voiced by Uzo Aduba) and her wife. But the movie has faced bigotry and backlash related to the kiss here in the United States as well. The latest example? A movie theater in Oklahoma recently posted a sign warning patrons about the scene and promising to “fast-forward through [it].” As NBC News reports, the 89er, a theater in Kingfisher, Oklahoma — a small town of…

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NEW YORK — A library on Long Island has voted to remove “all Pride displays” as well as Pride-related books from its children’s sections. The Smithtown Library Board of Trustees voted 4-2 Tuesday to ban any and all displays related to LGBTQ Pride from kids’ areas at Smithtown Library buildings, a move that was met with fierce backlash and call for action by advocates. The New York Library Association slammed Smithtown’s move, calling it “a direct violation of NYLA’s commitment to intellectual freedom and the freedom to read that libraries are entrusted to uphold.” The organization reaffirmed i…

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Two of Pornhub’s top executives resigned after the company was accused of having nonconsensual videos, including ones featuring minors, available on its website, Radar has learned.

The Daily Mail reported that MindGeek, which owns the adult website, stated this week that Chief Executive Officer Feras Antoon and Chief Operating Officer David Tassillo resigned after operating the website for more than a decade.

“Antoon and Tassillo leave MindGeek’s day-to-day operations after more than a decade in leadership positions with the company,” the company said in a statement. “MindGeek’s executive leadership team will run day-to-day operations on an interim basis, with a search underway for replacements.”

The New Yorker recently published an alarming report about the company, saying it allowed videos of underage and non-consenting people to show up on its platforms, including Pornhub, Brazzers, RedTube and YouPorn.

According to the Daily Mail, a spokesperson for MindGeek said Antoon and Tassillo’s departures had been planned since early 2022. Both will remain shareholders of the company, the outlet reported.

Antoon co-founded Brazzers in 2005 and later teamed up with Tassilo to buy Pornhub parent company Manwin in 2012. They renamed the company MindGeek in 2013, when the duo began controlling some of the most popular porn sites on the globe, the Daily Mail reported.

MindGeek blasted the New Yorker story, which detailed a 15-year-old British girl’s attempts to have explicit videos of her removed from the company’s websites.

“The New Yorker had the opportunity to seriously evaluate what works in fighting illegal material on the internet by looking at the facts, comparing the policies of platforms, and studying the results,” MindGeek’s statement said. “Instead, they chose to ignore the fact that MindGeek has more comprehensive and effective policies than any other major platform on the internet, and decided to peddle the same gross mischaracterizations that anti-porn extremists have spewed for decades.”

Alana Evans, president of the Adult Performance Artists Guild, a union for adult pornographers, told The Washington Post that the resignations likely would not have much of an effect on MindGeek’s websites.

“MindGeek is corporate porn,” she said. “Other owners and CEOs are far more involved in porn and the product.”

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By Andrew Chung and Lawrence Hurley

WASHINGTON (Reuters) -The U.S. Supreme Court on Thursday declared for the first time that the U.S. Constitution protects an individual’s right to carry a handgun in public for self-defense, handing a landmark victory to gun rights advocates in a nation deeply divided over how to address firearms violence.

The 6-3 ruling, with the court’s conservative justices in the majority and liberal justices in dissent, struck down New York state’s limits on carrying concealed handguns outside the home. The court found that the law, enacted in 1913, violated a person’s right to “keep and bear arms” under the U.S. Constitution’s Second Amendment.

The ruling, authored by Justice Clarence Thomas, declared that the Constitution protects “an individual’s right to carry a handgun for self-defense outside the home.”

Thomas added: “We know of no other constitutional right that an individual may exercise only after demonstrating to government officers some special need.”

The New York restriction is unconstitutional because it “prevents law-abiding citizens with ordinary self-defense needs from exercising their right to keep and bear arms,” Thomas added.

Liberal Justice Stephen Breyer wrote in dissent that the court had expanded gun rights without wrestling with the “nature or severity” of firearms violence in a country where there are more guns per person than any other nation.

“I fear that the court’s interpretation ignores these significant dangers and leaves states without the ability to address them,” Breyer wrote.

The justices overturned a lower court ruling throwing out a challenge to the law by two gun owners and the New York affiliate of the National Rifle Association, an influential gun rights group closely aligned with Republicans.

The decision represents the court’s most important statement on gun rights in more than a decade. The court in 2008 recognized for the first time an individual’s right to keep guns at home for self-defense in a case from the District of Columbia, and in 2010 applied that right to the states.

Gun rights, held dear by many Americans and promised by the country’s 18th century founders, are a contentious issue in a nation with high levels of firearms violence including numerous mass shootings. President Joe Biden’s administration backed New York in the case.

The United States has experienced hundreds of deaths from dozens of mass shootings in recent years. Just in recent weeks, 19 children and two teachers were killed on May 24 at an elementary school in Uvalde, Texas, and 10 people were slain on May 14 at a grocery store in Buffalo, New York.

The new ruling underscored how the 6-3 conservative majority on the court is sympathetic to an expansive reading of Second Amendment rights.

‘ABSOLUTELY SHOCKING’

New York Governor Kathy Hochul, a Democrat, called the ruling “absolutely shocking” and said she was “sorry this dark day has come.”

Under the New York law’s “proper cause” requirement, applicants seeking an unrestricted concealed carry permits must convince a state firearms licensing officer of an actual, rather than speculative, need for self-defense. Officials could also grant licenses restricted to certain activities, such as hunting or target practice.

The ruling could lead to many more people securing the licenses to carry concealed handguns in the state, undermine similar restrictions in other states and imperil other types of state and local firearms restrictions nationwide by requiring judges to scrutinize them with a more skeptical eye under the Constitution.

The ruling said that New York’s concealed firearm regime is at odds with the text and history of the Second Amendment and how gun rights were protected throughout U.S. history.

Firearms safety groups and gun control activists feared that a sweeping ruling against New York could undermine gun measures such as “red flag” laws targeting the firearms of people deemed dangerous by the courts, expanded criminal background checks for gun buyers or restrictions on selling untraceable “ghost” guns assembled from components purchased online. They also feared that such ruling could jeopardize bans on guns in sensitive places such as airports, courthouses, hospitals and schools.

The ruling will affect at least six states including New York, as well as the District of Columbia, that empower officials to decide whether people can carry concealed handguns in public even if they pass criteria such as criminal background checks. Three other states, Connecticut, Delaware and Rhode Island, also give officials some discretion, according to the ruling.

The ruling acknowledged that states can prohibit guns in “sensitive places” and that such prohibitions can likely go beyond what was historically considered a sensitive place, such as courthouses and legislative buildings.

Thomas wrote that courts “can use analogies to those historical regulations” of sensitive places.

But Breyer asked: “So where does that leave the many locations in a modern city with no obvious 18th- or 19th-century analogue? What about subways, nightclubs, movie theaters, and sports stadiums? The court does not say.”

Biden has advocated for new gun restrictions and has called firearms violence a “national embarrassment.” The U.S. Senate is poised on Thursday for a vote to advance a bipartisan gun control bill that supporters hope will help curb mass shootings in what could become the first new federal gun law in decades.

Conservative Justice Brett Kavanaugh in a concurring opinion said states can still impose requirements on people seeking licenses to carry firearms including fingerprinting, background checks, mental health checks and firearms training classes.

In another concurring opinion, conservative Justice Samuel Alito wrote that the court has said “nothing about who may lawfully possess a firearm or the requirements that must be met to buy a gun. Nor does it decide anything about the kinds of weapons that people may possess.”

Alito disputed that gun regulations like the one in New York would deter mass shootings, mentioning the recent Buffalo massacre.

“The New York law at issue in this case obviously did not stop that perpetrator,” Alito wrote.

(Reporting by Andrew Chung; Editing by Will Dunham)

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SAN JOSE, Calif. — Vowing that “we aren’t going anywhere,” the performer King Art Babe forged ahead Tuesday evening with the Alameda County Library’s first Drag Queen Story Hour event since a group of apparent Proud Boys members disrupted another reading earlier this month in San Lorenzo, Calif. No disruptions were reported Tuesday as the performer — bedazzled in heels, rainbow stockings, a frilly blue dress and a unicorn tiara — held a group of preschoolers and kindergarteners in rapt attention, flipping through several books about Pride parades and dressing in drag. Often, she stopped to rem…

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Monkeypox has been a hot topic of conversation, especially since the first probable case of monkeypox was discovered this week in New Jersey. It was discovered that monkeypox has been spread through sexual intercourse in almost all recent cases throughout the globe. This begs the question: Is monkeypox a sexually transmitted disease (STD)? Here’s what you need to know. What is monkeypox? When was it first discovered? According to the Centers for Disease Control and Prevention (CDC), researchers first discovered monkeypox in 1958 when a “pox-like” outbreak appeared on monkeys being kept for res…

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NEW YORK — Sylvester is getting a closer look. The late disco great is the subject of a “Sound Barrier,” a new documentary podcast that launched Wednesday on Spotify. Hosted by Dr. Jason King, a journalist, musician and New York University professor, the series will chronicle the musical career and impact of the genre-defying, gender-bending and influential icon. The vocal powerhouse behind timeless disco classics such as “You Make Me Feel (Mighty Real),” “Dance (Disco Heat)” and “Do You Wanna Funk,” Sylvester was a trailblazer in Black music and LGBTQ+ culture. Long before “Rupaul’s Drag Race…

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Jussie Smollett stood by his story regarding the homophobic and racist attack he allegedly encountered in January 2019, defending his innocence and sharing how he coped during his brief stint behind bars.

The embattled Empire star, 40, stopped by SiriusXM’s Sway in the Morningto give a post-jail interview and detailed how he gained clarity as well as renewed his spirit.

“God. And my family,” Smollett said about what he focused on while locked up. “I fasted for six-and-a-half days.”

The actor said his lawyer lied about his reason behind the fast, confirming that “I wasn’t fasting for lent, I was fasting because that’s what we do in my family.”

“I have never in my life, at least in my adult life, been as clear of mind as I was for those six and a half days,” he shared. “There was a part where they told me that I was getting out. Lord knows I wanted to get out.”

Although he was sentenced to 150 days following his conviction on five felony counts of faking his own hate crime and falsely reporting the attack to police, Smollett was granted the opportunity to post a bail of $150,000 and leave jail six days in.

As Radar previously reported, he spent four days in the psych ward over concerns about his mental state. He later spent two days in the jail’s general population.

His team claimed the conditions inside the Chicago jail were “unacceptable” prior to his release.

During his interview, Smollett didn’t address what will happen if his appeal fails, and he has to go back to jail and complete the remainder of his sentence.

Smollett said he is fully aware that a lot of people still believe the alleged attack was a hoax, adding, “I absolutely understand why people felt betrayed. And I put that in my song Thank You God.”

“If I had done something like this, it would mean that I stuck my fist in the pain of Black Americans in this country for over 400 years,” he doubled down. “It would mean that I stuck my fist in the fears of the LGBTQ community, all over the world. I’m not that mother f—–, never have been.”

Smollett said he’s in good spirits these days and is avoiding negative energy. Plus, he’s also in therapy.

“I’m going where the love is,” he added. “Why should we subject ourselves to unnecessary pain or salaciousness or whatever. That’s why I come home to family.”

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New research provides evidence that sexual identity changes tend to be associated with increased psychological distress among young women. But the findings, published in the Journal of Health and Social Behavior, indicate that this association primarily impacts women who move towards more same-sex orientations. “There is a perception in our society that sexual orientation, and thus a person’s sexual identity (e.g., bisexual, lesbian, straight), sits inside them from the day they were born and does not change across their lives,” said study author Alice Campbell, a postdoctoral research fellow …

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