WHO monkeypox expert details challenges, next steps in emergency preparedness

The monkeypox outbreak continues to grow globally with over 14,000 cases in the U.S. alone, according to the U.S. Centers for Disease Control and Prevention.

Dr. Rosamund Lewis, the World Health Organization's Technical Lead for the monkeypox outbreak, spoke with "ABC News Live" Thursday about the latest updates and what health agencies are doing to combat the spread.

ABC NEWS: Thank you so much for your time tonight, Dr. Lewis. Big picture is the World Health Organization's thinking about declaring monkeypox a pandemic.

LEWIS: At the moment, the situation is that there are 38,000 cases of monkeypox in the world reported.

It certainly is a concerning figure that the number of cases continues to rise. On the 23rd of July of this year, the World Health Organization declared a public health emergency of international concern. This is under the international health regulations, and it is the highest level of alert the WHO can already declare. So, we are on alert and doing everything possible.

ABC NEWS: So focusing a little bit on the U.S., [which] accounts for about a third of all cases worldwide. Why do you think that is?

LEWIS: There are a number of countries that have concerning situation. So, at the moment there are other countries in the Americas that are also seeing steep increases in the number of cases. And part of that may be the spread of the virus. Another component may be increasing access to testing. There are countries in Europe that began their outbreak earlier and they are already beginning to see some sort of leveling off of the new cases being reported.

ABC NEWS: Dr. Lewis, when you speak about control, 98% of the cases have been among men, almost all of whom are men who have sex with other men. How can you balance the need to warn gay men that they're at higher risk without stigmatizing them?

LEWIS: It's a really fine line to walk and it's a really most important question, so thank you for that. It's the most important work that any public health agency can be doing right now and working with community organizations of people who are affected by this outbreak. Contributing to stigma is not a solution and not for anyone. Because what happens with that is it actually undermines the outbreak response. Contributing to stigma, in any way, may drive people away from testing, [and] drive people away from seeking vaccines. They may even drive people away from seeking care. And so in that way, the outbreak can continue to spread.

ABC NEWS: To your point that all segments of the population feel supported, we would like to do a quick rapid fire round through some of the common questions that people may have. I hope you're okay with that. First up, can the virus be spread among people with no symptoms?

LEWIS: This is something we don't know yet. We do know that people can have infection without symptoms, but it is not yet known whether they can spread it at that time. That's another area that we're monitoring very closely.

ABC NEWS LIVE: Can you get infected twice?

LEWIS: This has occurred. People have been infected more than once. We don't know yet how often this might happen.

ABC NEWS LIVE: And what are the first signs of infection?

LEWIS: So the first symptoms have been fever, feeling unwell, backache, muscle aches, and then followed by a rash. And now we're seeing right now sometimes that is flipped around. Sometimes people are having a rash and then followed by fever or other symptoms, and the rash can be milder or can be more severe. We are basically seeing a whole range of how this disease can present right now.

ABC NEWS LIVE: Lastly, Dr. Lewis, with schools starting across the globe, there is a concern about cases starting to spread more among children. What do people need to know in that context?

LEWIS: So this pattern, as you described, has been very consistent. And the folks who are at higher risk and need to figure out what information, they need to protect themselves are people who are having predominantly multiple sexual partners.

It doesn't have to be only men. It can be other groups who may be having active sexual activities with people that they don't know so well or in situations where they're multiple partners at once. So this could happen on a college campus, for example. Obviously, we're talking about young people here.

The risk to children is really quite low at the moment because the spread in general population has not really manifested; it's not taken off. We have seen some children exposed in different ways, but the numbers are really very small at the moment. Usually, that happens in a household setting and that is typical. That is very common.

It's always been known that people can transmit through hugging, kissing, whether that be household members who also share towels, for example. And so historically, for monkeypox, that has been described as the mode of transmission-close proximity in the household.