(Editors Note: A prior version of this article was updated on August 9, to clarify monkeypox vaccine eligibility and which medical providers received allotments.)
The global monkeypox outbreak is occurring primarily in gay, bisexual and other men who have sex with men. For the general public, the current risk of contracting monkeypox remains very low.
While vaccination is an important component in containing the outbreak, the demand currently outweighs supply. The region receives monkeypox vaccine from the California Department of Public Health based on a statewide allocation formula.
Given the limited vaccine supply at this time, the Centers for Disease Control and Prevention recommends the monkeypox vaccine for the population most at risk. These are people exposed to someone who has already been diagnosed with confirmed or probable monkeypox infection and those with immunocompromising conditions who are at greater risk of developing severe disease or complications if they contract the virus.
This week 1,550 vaccine doses were allocated to the region and have been sent to designated healthcare systems, federally qualified health centers and clinics in the region. For those eligible and who also have a referral from a healthcare provider, vaccines are available by appointment only:
CountyPublic Health Centersalso have about 300 doses of vaccine available by appointment only and based on the eligibility criteria detailed above.
Testing is widely available through healthcare providers and involves using a swab to sample suspect skin lesions. People with no healthcare provider, who need testing, can call 2-1-1 to be referred to a provider. 2-1-1 is not presently providing vaccination appointments.
The monkeypox vaccine is a two-dose series, administered 28 days apart. Following guidance from the California Department of Public Health, given the low supply of vaccine, the County is presently recommending that first doses be administered to as many eligible people as possible. One dose of the monkeypox vaccine is 80% effective. Second doses will be administered when more vaccine is available.
Our goal is to get one dose into as many peoples eligible arms as possible, said Wilma Wooten, M.D., M.P.H., County public health officer. When we get more vaccine, we can start giving second doses for even higher efficacy.
Since late May, the County has received 4,687 doses of monkeypox vaccine. Of those, 3,251 have been distributed and 2,267 have been administered. The number administered might be higher because it takes a few days for the vaccine registry to be updated. As more doses are allotted to the region, the County will expand distribution.
For more information about monkeypox, including risk-reduction measures that those at risk can take, visitthe Countys monkeypoxwebsite, which is updated at about 4 p.m. each weekday afternoon. To receive text messages about monkeypox, text COSD MONKEYPOX to 468-311.
DOH spokesman Jeremy Redfern said although the virus is considered low risk for the general public, agency officials expect more people to get sick.
That being said, due to the lack of monkeypox vaccines from the federal government, we are expecting infections to increase, Redfern said in an email. Monkeypox is proving to be extremely painful for those infected, but the fatality rate remains at zero in the US.
The nationwide increase in monkeypox infections prompted President Joe Biden to declare a public health emergency last week. Data from the U.S. Centers for Disease Control and Prevention show New York is leading the nation with 1,960 infections as of Sunday, followed by California with 1,310 cases. The governors of those states each signed an emergency declaration as cases went up, but the Florida Department of Health has no plans to ask DeSantis to declare an emergency.
We work with providers, hospitals, and clinics to ensure they are able to properly diagnose a case of monkeypox and report the case to their county health department for further testing, Redfern wrote.
An emergency declaration allows the states government to coordinate with agencies, impose special restrictions and sign contracts outside of state procurement laws.
Florida Gov. Ron DeSantis and Ladapo have downplayed the impact of the monkeypox virus, with DeSantis saying last week when Florida was fifth in the nation for infections that politicians and the news media are using the virus to scare people.
Two Democrats vying to unseat the incumbent Republican also demanded that DeSantis take more action. Florida Agriculture Commissioner Nikki Fried said after a Tuesday campaign-related news conference in the parking lot of the governors mansion that her office has called on HHS to provide the state with more vaccines. She also urged the DeSantis administration to take the impact of the virus more seriously.
Fried said she recognizes that emergency declaration powers may not be necessary for monkeypox when compared to the ongoing Covid-19 pandemic, but outreach efforts are key at preventing the virus from spreading, usually through direct human contact.
Its more so that we can say that this is serious, that weve got an issue here, and that we are starting to work with our local governments to provide the resources of vaccines and testing, Fried said. The whole thing about monkeypox is knowledge is power.
Fried will face Rep. Charlie Crist (D-Fla.) in the Aug. 23 primary, and the winner of that race will face off against DeSantis in November. Crist said during a Tuesday interview that DeSantis should be looking for ways to receive more vaccines from HHS rather than just downplaying the issue. With awareness playing such a crucial role in preventing spread, DeSantis should be pulling more levers that he has at his disposal in the event of a problem.
We know that testing is difficult, and the cases are probably more than we will ever know, Crist said during a phone interview. The thing to do here is be engaged, and the governors just not engaged here.
Fried and Crist have also called on the Biden administration to acquire more vaccine doses. The U.S. endured a shortage of the Jynneos vaccine used to treat monkeypox after the first infections were reported in May.
By declaring a national emergency, Biden has started a process the federal government has to follow before it changes a vaccine-use authorization. In Florida, Redfern said the state can direct counties to conserve shots without a declaration, and that the states actions were to accommodate for delays in vaccine distribution by the federal government.
A state of emergency cant do much to speed up something that is physically unavailable, Redfern said.
One LGBTQ coalition is already planning its own outreach efforts to alert high-risk Floridians. National Black Justice Coalition Deputy Director Victoria Kirby York said Florida officials have failed to account for the states status as one of the most popular tourist destinations in the country, with millions of visitors hitting the beach every summer. She said previous governors, from Crist to Jeb Bush, showed compassion for human beings.
Governor DeSantis has done nothing but show that every decision hes making is about a presidential run, Kirby York said. It has little or nothing to do with the well-being of the people of Florida.
The National Black Justice Coalition was one the groups picked by drugmaker Gilead Sciences on Tuesday to receive part of a $5 million grant meant to help promote awareness about monkeypox. Kirby Yorks organization refers to the monkeypox virus as MPV due to its racial undertone.
If we want to stop this, we need to change the trajectory, and start getting into those communities and letting people know, she said. Youd think wed know by now that viruses always start in a community.
Three monkeypox vaccine events will be held in New Orleans and Baton Rouge this week, health officials said Tuesday.
Monkeypox has been identified in several individuals so far in the New Orleans area, and Louisiana officials said there are likely more undiagnosed cases.
The virus isspreading mostly through close, intimate contact, and many reported caseshave been diagnosed in men who have sex with men,according to the U.S. Centers for Disease Control and Prevention.
There are not enough shots to currently meet the demand in Louisiana, and the events this week will be offering a limited number of vaccines on a first-come basis to eligible people, according Mindy Faciane, spokesperson for the Louisiana Department of Health.
Several clinics around the state are also offering vaccines to eligible people by appointment only. Here's the full list.
Tuesday from 4 p.m. to 7 p.m.: The Phoenix Bar, a 24-hour gay bar in the Marigny, is hosting a shot-for-shot event in partnership with the health department.
The business says 300 vaccines will be given out on a first-come, first-served basis to people who meet the eligibility criteria.
HIV testing, COVID vaccines and PrEP counseling also will be available at the event, Phoenix says.
After receiving a monkeypox shot, the customer will get a free shot of alcohol, Phoenix says. The bar also plans to offer free bottled water, snacks, music and drink specials. Read more about the event.
Thursday from 5 p.m. to 9 p.m.: The Page, a gay bar at the edge of the French Quarter, is hosting a free vaccine event on Thursday to people to meet the eligibility requirements. Health officials didn't immediately know how many shots would be available.
The bar is 542 North Rampart Street.
Thursday from 4-7 p.m.: Out of the Box LGBTQ Center is hosting a free vaccine event for eligible people on Thursday. It wasn't immediately clear how many vaccines would be available.
The center is at 9148 Scotland Avenue. Read more.
Here are the eligibility criteria for the vaccine, as outlined by the Louisiana Health Department.
U.S. officials on Thursday declared a public health emergency over the outbreak, which has infected more than 6,600 Americans.
Monkeypox has been detected in Louisiana.
Monkeypox is a potentially serious virus that typically causes flu-like symptoms, swelling of the lymph nodes and a rash with bumps that are initially filled with fluid before scabbing over, according to the Louisiana Health Department. Most infections last two to four weeks.
Here's what the state Health Department says you need to know about monkeypox.
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Sometimes people get a rash first, followed by other symptoms; others only experience a rash. Some people infected in the U.S. have experienced only isolated rashes in the genital region or other body parts.
Monkeypox spreads in different ways, officials said. The virus is most often spread through direct contact with a rash or sores of someone who has the virus.
People stand in long lines to receive the monkeypox vaccine at San Francisco General Hospital in San Francisco, on July 12, 2022.
It can also spread through contact with clothing, bedding and other items used by a person with monkeypox, or from respiratory droplets that can be passed through prolonged face-to-face contact, including kissing, cuddling or sex.
People who do not have monkeypox symptoms cannot spread the virus to others.
According to the CDC, early data suggest that gay, bisexual and other men who have sex with men make up a high number of cases. However, anyone who has been in close contact with someone who has monkeypox is at risk.
Take basic steps to prevent the spread of monkeypox. Anyone with exposure or infection concerns should refrain from intimate or close personal contact and seek medical attention. If you do not have a health care provider, visit a parish health unit near you. Laboratory testing for monkeypox is now widely available, officials said.
Treatments and vaccinations are available for monkeypox, but physicians say bureaucratic red tape is hindering their ability to respond to and contain the outbreak.
The monkeypox treatment, TPOXX, is available only to patients and doctors under a special CDC status, because it is usually used to treat smallpox, not monkeypox.
The expanded access status requires physicians to go through more than 100 pages of paperwork each time they prescribe it. Between the forms and administrative requirements, a patient visit to initiate this medication can take one to three hours.
As a result, many people who need the drug are not receiving the necessary treatment, and the bureaucratic hurdles are hitting uninsured and minority communities particularly hard, said Mary Foote, the medical director for emergency preparedness and response in the New York City Department of Health and Mental Hygiene.
Bavarian Nordic's Jynneos is one of two vaccines that may be given in the U.S. to prevent monkeypox. The government has many more doses of the other vaccine, an older smallpox vaccine called ACAM2000 that is considered to have a greater risk of side effects and is not recommended for people who have HIV. So its the Jynneos vaccine that officials have been using as a primary weapon against the outbreak.
The Centers for Disease Control and Prevention recommends the vaccine for people who have already been exposed to the virus and their presumed contacts. That includes men who have recently had sex with men at parties or in other gatherings in cities where monkeypox cases have been identified.
The CDC estimates that about 1.5 million American men are eligible for the vaccine based on their HIV status and other risk factors.
The Associated Press and CQ-Roll Call via the Tribune Content Agency contributed to this story.
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People living with HIV and other immunocompromised medical conditions remain ineligible to receive the vaccine. They hope an increase in supply will change that.
HOUSTON The monkeypox virus continues to spread locally and nationwide.
The Center for Disease Control and Prevention reports 9,492 cases in the U.S. The Texas Department of State Health Services says 701 of those are in Texas. Local health officials report 223 cases in Harris County including 195 in the city of Houston.
Now, local health departments are gearing up to administer more vaccines using a new method authorized by the FDA. It should increase the vaccine supply but for now, there are no changes to who is eligible for the shot.
That means people with HIV are still not eligible.
"I really feel unsafe," said Josh Mica.
Mica wishes he could roll up his sleeve to get the shot.
"I don't qualify," said Mica. "A lot of my friends have had to lie to get this vaccine."
Despite living with HIV, he and others with HIV and other immunocompromised conditions remain ineligible to receive the vaccine.
"They're marginalizing one community over another one, and this time they're marginalizing the HIV community," said Mica.
"We do fully recognize that people who have immunocompromised medical conditions like HIV are at increased risk for complications should they become infected," said Houston Health Authority Dr. David Persse.
But local health officials say it comes down to vaccine supply.
"Given the amount of vaccine we have, even with the expanded guidance for the vaccine, it's still not enough for all those who are potentially eligible," said Harris County Health Authority Dr. Ericka Brown.
The city and county are working to train their teams on how to administer the vaccine via 'intradermal injection' which means just under the skin. It's a smaller dose that will help increase vaccine supply.
"Once we get enough vaccine, we can broaden the criteria for people at higher risk of complications," said Persse.
In the meantime, Mica says he has no choice but to be extra careful.
"I don't go out and socialize with friends," said Mica. "We're going back to how things were with COVID."
County and city health officials say although most monkeypox cases are overwhelmingly among men who have sex with men, monkeypox is not an STD and not a virus only impacting one group of people.
"For whoever thinks this is a gay, MSM problem only, we are already seeing in the U.S. spread within households," said Persse. "The general public needs to know about this so they can protect themselves as well.
Both Houston Health and Harris County Public Health say they hope to be ready to administer the vaccine via the new method within a week's time.
They say they are still taking appointments for vaccinations to be administered via the previous method until intradermal injections are ready to go.
New monkeypox vaccine plan may stretch nation's limited supply
The U.S. will use smaller doses of the monkeypox vaccine in order to stretch its supply.
Scott L. Hall, USA TODAY
What is monkeypox? How do you get? Whos at risk?
The viral disease has infected over9,000 people in the United States, many cases coming after the World Health Organizationdeclared it a public health emergency in July.
The Centers for Disease Control and Prevention has reported55 cases in Tennessee, including at least one in Knox County.
To help dispel misinformation, Knox News spoke with Dr. Eric Penniman of Summit Medical Group at Middlebrook to get answers straight from a family medicine physician.
Dr. Eric Penniman: Its mostly spread through close and intimate contact with somebody who has it. So, it's not like COVID, which is spread through respiratory secretions and right now spreading very, very rapidly.
From USA TODAY: Biden administration declares monkeypox a public health emergency
Read this: As monkeypox spreads, vaccine is available in Knox County. Heres who needs it most.
(Monkeypox)does not spread rapidly because you have to have very close intimate contact, typically. But (theres over9,000)cases now in the US, so it's something that people should be aware of, particularly people who are high risk.
It's spread mostly through skin-to-skin contact, specifically the fluid of one of the pustular lesions that gets on someone else's skin or spread through respiratory secretions. So, direct kissing, sharing saliva, things like that. Now somebody coughs on you and you're in close proximity, there's a chance that you could get infected as well.
The high-risk group are men who have sex or intimate relations with men, and that's mostly what we're seeing. We've seen a few cases (between family members). Family members in close contact with somebody who is infected should take caution, for sure. But so far, it's mostly a sexually transmitted disease.
Although, there is a possibility that it could be spread through direct contact with the respiratory secretions of somebody infected.
If you're a human being you're slightly at risk, certainly. The high-risk people are the ones that were most focused on, communicating to and beginning to vaccinate those in the high-risk category because the whole point of declaring a public health emergency is so that we can increase the communication and get those people vaccinated who are in high-risk groups so that hopefully we can stop spread altogether.
It would be laboratory workers who are working with samples, testing for monkeypox, as well as men who have sex or intimate relations with men.
Right now, I think the only place to get the vaccine is through (the Knox County Health Department). They do have some monkeypox vaccines but in very small quantities. The government has committed to helping to ramp up the production so that we can get high-risk people vaccinated, which should hopefully prevent somebody from getting it. And it's even effective after someone has been exposed, specifically if it's within four days of being exposed to monkeypox, getting vaccinated may help that person avoid it altogether.
The incubation period is 3 to 17days.
Isolation of those infected is very, very important and we're early enough in this outbreak to halt it.
(Someone with monkeypox is)no longer contagious once their skin lesions have healed and new skin has grown over. At that point, they're no longer contagious. So, if there's (over9,000)cases in the United States, if those (9,000) plus Americans will stay isolated, then we should stop this spread of monkeypox throughout the United States.
Fact check: Monkeypox is not a side effect of the COVID-19 vaccine, experts say
Be ready: It's almost time for back to school. It's time for you to talk about monkeypox.
The bottom line is that it's largely preventable with vaccines as well as responsible people who are infected isolating. And there are some treatments for monkeypox if somebody were to get infected. It's definitely not anything to be embarrassed about and not seek medical care.
If you think you have been in contact with somebody (infected), get a hold of your physician or your local health department right away so that appropriate measures can be taken.
End of Q&A with Dr. Penniman, which has been edited for clarity and length.
Monkeypox is a viral disease that typically starts with flu-like symptoms like fever, swollen glands, muscle aches and headaches, and then a rash usually develops a few days later.
However, with the 2022 worldwide outbreak, the rash tends to be the first symptom. Lesions are first appearing in the mouthanus, and genital areas.
The illness typically lasts 2-4 weeks.
Though the 2022 outbreak has been linked to sexual and intimate contact between men who have sex with men, the CDC does not classify monkeypox as asexually transmitted disease and some experts say it could be problematic to frame it as such or reporting it as an illness that is only affecting men who have sex with men.
"Many people (may) think, 'Well, I'm not having sex. I'm not a gay man. So, I'm good no matter what.' When in reality, monkeypox is a contact-based disease," Dr. Stella Safo, an HIV primary care physician and founder of Just Equity For Health recently told USA TODAY.
Vaccines for monkeypox are available at the Knox County Health Department but supply is limited and those who are high-risk should look get vaccinated.
Call the health department at 865-215-5000 for more information about monkeypox vaccine access and monkeypox information.
Maricopa County Department of Public Health (MCDPH) has received limited, additional doses of monkeypox vaccine from the federal government. MCDPH is prioritizing vaccinating those who are at highest risk of exposure to slow the spread of disease in accordance with federal requirements.
In this outbreak we know that some people are at higher risk of getting monkeypox than others, just like some groups are hit harder by diseases like cardiovascular disease or asthma, said Dr. Nick Staab, medical epidemiologist at MCDPH. At this stage in the outbreak, for most people, the overall risk of being exposed to monkeypox remains very low. For household and social contacts of people who have gotten monkeypox and others at increased risk, we want to make sure they get the protection they need so we can slow the spread at this early stage.
With vaccines coming in varying quantities at irregular intervals, MCDPH is asking people who are interested in getting vaccinated to let MCDPH know so that they can be notified as vaccine doses become available. People can check eligibility atMaricopa.gov/monkeypox, where they will also find a form to get notified about upcoming vaccine opportunities.
Monkeypox is most commonly spread through prolonged skin-to-skin contact with someone who is infected with monkeypox. Prevention measures for monkeypox are similar to those that reduce the spread of other viruses that spread in a similar way:
Symptoms often start with a fever, which may be accompanied by:
One to three days after fever starts, a rash begins, often starting on the face before spreading to other parts of the body. The rash may begin as small, flat, round discolorations that become raised and fluid-filled (clear or pus) before scabbing. These spots and the fluid in them carry virus that can infect others. Once scabs fall off, the area is no longer infectious. These spots or lesions can appear anywhere on the skin, genitals, or inside the mouth. MCDPH is encouraging healthcare providers to offer testing for patients who present with monkeypox symptoms and a new, suspicious rash. Most patients with monkeypox fully recover from the virus without treatment.
We have the tools we need to contain spread, added Dr. Staab. Vaccines are available to those who are at higher risk of exposure, testing is available through commercial labs, and treatment is available for people who are infected and at higher risk of severe illness. With a federal emergency now declared, there may be more vaccine doses and other resources that will be available in the coming weeks and months.
For local information, visitMaricopa.gov/monkeypox; for national information, visitCDC.gov/monkeypox. Residents needing assistance with the website or interest form can contact MCDPH at (602) 506-6767 for assistance.
Vaccine images and B-roll are available upon request.
Shares of COVID-19 vaccine maker Novavax cratered Tuesday as the U.S. biotech company slashed its sales forecast due to a slump in demand for its shots. The company's stock dived 31% after it cut its 2022 sales outlook in half.
Novavax's protein-based vaccine was a latecomer to the market. It was authorized by the Food and Drug Administration for use by adults in the U.S. onlylast month, long after a majority of adults had already been vaccinated with Pfizer, Moderna or Johnson & Johnson shots. Only 7,381 Novavax vaccine doses have been administered in the U.S., government data shows.
The company alluded to softening demand for the COVID-19 vaccine in its earnings call Monday. Novavax CEO Stanley Erck said that hurdles in getting approval to administer booster shots and first doses to younger Americans have also hurt sales, as these applications are the company's best bet for finding a market.
The Novavax COVID-19 vaccine has not been authorized by the FDA for use as a booster vaccination.
"Receiving booster and adolescent label expansions globally has taken longer than expected, and expanding our label is our core commercial priority. When coupled with global oversupply, this drove a shift in demand for our vaccine from the second quarter into the second half of the year and into 2023," Erck said in the call.
Novavax does not expect any additional revenue through Covax, an international alliance aimed at ensuring vaccine equity by delivering doses to low- and middle-income countries. The company had expected to sell 350 millions shots through the partnership.
Wall Street analyst Adam Crisafulli of Vital Knowledge highlighted Novavax's earnings miss. Revenue for the second quarter came in at $186 million, versus Wall Street forecasts of $975 million.
Novavax slashed its full-year earnings guidance to $2 billion to $2.3 billion, from a previous estimate of $4 billion to $5 billion.
"It's just an issue of earnings and guidance. The report last night was pretty disappointing and the guidance was slashed significantly. From a bigger-picture perspective, there's a sense that the COVID opportunity is diminishing overall while Novavax just came out of the gate too far behind the mRNA products," Crisafulli told CBS MoneyWatch.
The new poll shows that only 19% of people age 50-64, and 44% of people over 65, have gotten two booster doses.
With officially reported cases surging in recent weeks, and many more cases going unreported because results of at-home tests arent tracked, the poll has some surprising findings about older adults experiences with the disease and testing.
In all, 50% of those aged 50 to 64, and 69% of those over age 65, said they had never had COVID-19 by late July 2022.
In the 50-to-64 age group, 29% said they had had COVID-19 once, 9% said they had had it more than once, and 12% said they may have had it but werent sure.
In the over-65 group, 24% said they had had it once, 2% had had it more than once and 5% said they may have had it.
At-home tests, which were scarce until early 2022 and have been made available for free through the federal government, health insurance companies and community locations, have been used by 44% of older adults. The percentage who had ever used an at-home test was highest among those aged 50 to 64, those with higher incomes and education levels, and those who are working.
Meanwhile, 57% of older adults had had PCR testing, which is what feeds the official reporting of COVID-19 rates, but has become less widely used in recent months given the ease and availability of at-home tests. The same groups that were more likely to have used at-home tests were also more likely to have had a PCR test.
SEE ALSO: Which older adults are getting their flu shots and COVID boosters?
But 28% of those over age 65, and 22% of those age 50 to 64, said they had never been tested for COVID-19. Those with high school educations or less, and those with incomes under $30,000, were most likely to say this.
Of those who said they had had COVID-19 at least once, 21% said they had never gotten a test but had had symptoms. Meanwhile, 53% of this group said they had tested positive on a home test and 43% said they had a positive PCR test; respondents could indicate that they had tested positive on both kinds of tests.
Fall booster attitudes varied based on COVID-19 history. Two thirds (66%) of those who had not had COVID-19 by the time they took the survey, and had received a COVID-19 vaccine in the past, said they were very likely to get a fall booster, as did 56% of vaccinated people who had had COVID-19 once.
Meanwhile, 39% of those who had had COVID-19 more than once, and had received at least one dose of COVID-19 vaccine, said they were not likely to get a booster this fall.
The poll also asked older adults if they plan to get vaccinated against influenza this fall; the optimal time for this years flu shots is likely to coincide with the availability of new COVID-19 boosters. Vaccine experts have advised in the past that the two vaccines can be given at the same time.
The difference between the two age groups was striking:
74% of people over 65 said they were very likely to get a flu shot, compared with 46% of people age 50 to 64.
Another 13% of the younger group, and 6% of the older group, said they were somewhat likely to get a flu shot.
Education level made a big difference in flu shot likelihood, with 70% of those who have college degrees or higher saying they are very likely to get a flu shot, compared with 53% of those whose formal educations ended earlier.
Three quarters (75%) of those who said they were very likely to get a flu shot were also people who had gotten at least one dose of COVID-19 vaccine and said they were very likely to get a fall COVID-19 booster.
In contrast, 20% of those who have never gotten a dose of COVID vaccine said they were likely to get a flu shot.
We cant forget that flu can pose a threat to older and more medically vulnerable adults, and the same precautions that work against COVID-19 vaccination, masks, good ventilation and keeping sick people away from others until their symptoms are over work against flu, says Malani. Although we avoided a twindemic of both viruses at once last winter, its not clear well be so lucky again this winter. I encourage everyone to follow the CDC recommendations for their age and health status regarding vaccination and prevention.
The National Poll on Healthy Aging results are based on responses from a nationally representative sample of 1,024 adults aged over 50 from the Foresight 50+ Omnibus panel, which draws from the Foresight 50+ Panel by AARP and NORC at the University of Chicago who answered a wide range of questions online and by phone in late July, 2022. Questions were written, and data interpreted and compiled, by the IHPI team.Read past National Poll on Healthy Aging reports.
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