Monkey pox in children: What you need to know

With monkeypox on the rise, the World Health Organization recently declared monkeypox an international public health emergency, targeting people who may be at higher risk of severe illness from the virus, including children, pregnant women, and those who are immunosuppressed.

Last week, CDC Director Rochelle Walensky announced that two children in the U.S. had actually tested positive for monkeypox, and we’ve seen the first human case in the U.S. during pregnancy. Additionally, the Indiana Department of Health reported Friday that two of the state’s 45 cases were in children.

Still, while making these game-changing announcements, public health experts stress that the vast majority of cases they see are still in men who have sex with men. At least for now, they say, it’s the community that needs more attention and access to vaccines and testing.

Of the two children reported by the CDC to be infected with monkeypox, one is a baby in California and the other is an international visitor from the UK who is currently being treated in Washington. Both are being treated with the drug TPOXX (tecovirimat), which is currently only available through a new drug approval.

With summer over and school soon to start, Monkeypox Twitter is worried.

parents the and teachers worry about how safe it is to go back to school. Others worry about a pediatric-wide epidemic a full-blown pandemic could break out or may cause lack of personnel. And in one of the most common sentiments, LGBTQ+ people and allies fear agencies that continue to focus on gay and bisexual men, even when other people are infected with the virus. Puts LGBTQ+ people at risk for the further improvement of society, especially those who work with children.

Dr. Jennifer McQuiston, who heads the CDC’s monkeypox response, said their experts are studying how the virus can spread, including in schools, daycares and camps. But based on the data he’s seen so far, McQuiston doesn’t think there’s any chance of monkeypox outbreaks in schools.

“It’s not something we worry too much about,” he said. “There is occasional familial transmission, but there is no evidence of transmission in pediatric populations.”

In the current global monkeypox epidemic, as of July 28, 21,148 cases were reported from 78 countries, including 20,804 cases in 71 countries where the disease had not been observed before. That includes 4,907 in the U.S. — more than double the number from a week ago. The first pediatric cases reported in the US are not the first of the disease. According to the World Health Organization, 84 children under the age of 18, including 24 children under the age of 5, have been affected worldwide so far, including in the UK and Spain. Six adults have died, including three in Nigeria, two in the Central African Republic and one in Brazil.

Here’s an overview of pediatric monkeypox, including information on how the disease spreads in the home, how to protect your family, and what schools are doing to keep children safe.

Is monkeypox dangerous for children?

Although children are thought to be more likely to get sick from monkeypox than adults, this data is based on a more dangerous strain than the virus currently circulating in the US and other states.

The first two pediatric cases reported by the CDC in the U.S. were said to be relatively mild. The CDC has published clinical guidelines for doctors on how to diagnose and treat monkeypox in children, which can have more severe symptoms in children younger than 8 years old, as well as in people who are immunocompromised or have certain skin conditions such as eczema, burns or severe acne. But again, this information is based on a dangerous version of the virus. The data currently circulating around the world is limited, but it is being generated in real time.

“While the children in the United States that we know have been sick, they have not been sick and are now doing well. I think hopefully the number of kids will stay low,” McQuiston said.

The most common symptoms of monkeypox in children are the same as in adults—they include fever, headache, muscle aches and weakness, and then develop into pimple-like, blister-like sores. There may also be sores inside the mouth that can be mistaken for canker sores.

Are there any treatments for monkeypox in children?

Although treatments and vaccines are available for children who have or have been exposed to monkeypox, they can be difficult to obtain.

Both the infant and toddler who tested positive for the virus in the US were given the antiviral TPOXX to reduce the chance of severe illness. Currently, the drugs are only available through a new drug approval, which requires patients to get special approval and undergo a series of doctor visits and health evaluations.

Current smallpox vaccines (monkeypox is in the same family) have been shown to be at least 85% effective in preventing infection and also help relieve symptoms if given within four days of exposure, preferably. Supplies of the selected Jynneos vaccine remain limited, but appointments are prioritized for recent exposures, including children.

Some activists say this reactive approach to protecting children from monkeys is not enough. Among them are Fatima Khan, founder of Protect Their Future, a grassroots organization working to ensure children are prioritized in public health policy; They led the fight for approval of COVID vaccines for children under 5 years of age. The organization issued a statement on July 28 calling on officials to prioritize children and pregnant women in cases of monkeypox.

“We need to ensure that children are not left behind,” Khan said. “Our government must urgently come up with a plan on how to make it easier for children to be vaccinated with the Jyneos vaccine.”

What should pregnant women know about monkeypox?

According to McQuiston, the CDC has “a lot of concern” about monkeypox and pregnancy, especially during childbirth. Pregnant women should take extra precautions to protect themselves from monkeypox, especially if they are nearing their due date.

“We have concerns that this could be a very difficult course,” he said.

The World Health Organization has warned that monkeypox during pregnancy can cause the fetus to become infected with the virus or, at worst, cause stillbirth. A 2017 study in the Journal of Infectious Diseases of four pregnant women with monkeypox showed that one had a healthy baby, two had early miscarriages, and one was stillborn. Fortunately, a baby recently born to a mother with monkeypox in the US appears to be doing well so far.

“The baby looks healthy right now,” McQuiston said.

Can monkeypox spread in schools?

Experts say monkeypox is more likely to spread at home than at school, and those who suspect the virus may be present in their home should take precautions.

In looking at possible routes of transmission, the CDC emphasizes prolonged and personal contact, such as in cohabiting households. CDC-confirmed pediatric cases previously reported in the US are said to have been transmitted from a family member living in the same household.

“We know that monkeypox is spread through close contact, petting, kissing, sharing dishes,” McQuiston said. “That’s why we recommend self-isolation if someone has monkeypox and they live with other people.”

People who think they have monkeypox are advised to avoid close contact with others, especially children. CDC recommends that caregivers wear gloves and masks if contact can be avoided, as in babysitting. In any household with a suspected case of the virus, the agency recommends that everyone age 2 and older wear a mask.

What are schools doing to prepare for monkeypox?

Although public health officials say schools are not a primary concern for the spread of monkeypox, officials are preparing for the possibility.

As the summer heat subsides and schools begin to talk about plans to reopen, Hany Protect Your Future worries that children may be the main driver of this epidemic.

“When monkeypox starts spreading in schools and kindergartens, the impact can be devastating,” he said.

The New York City Department of Education is the largest school district in the United States and serves more than 1 million students in 1,851 schools spread across New York’s five boroughs. Most of them will open in September. 13.

Caliris Salas-Ramirez sits on the department’s Education Policy Panel, which is made up of 15 members appointed by the mayor and five elected city presidents. He believes it is important for the panel to start talking about how to protect children from monkeypox.

“We’ve got to have a plan because we’re in a rush right now and lord knows what it’s going to be like in the fall,” he said. “We need to start teaching our kids about monkeypox and what they can do to keep themselves safe.”

Salas-Ramirez, a professor at the City University of New York School of Medicine, said COVID presents an opportunity to teach children how to protect themselves and their communities from viruses.

“Pedagogically, we try to remind the administration that this is a learning opportunity for kids,” he said.

But he expects an uphill battle. It took more than four months to meet with the city’s health department about the upcoming school year, even though more than 40 New York-area school children have died from COVID. The meeting will be held in August. 4 and includes a discussion of monkeypox. Salas-Ramirez hopes the department will listen to her concerns, but she’s not holding her breath.

“If a child is not feeling well, if all their needs are not being met, they are not going to function optimally, but we continue to have these conversations in isolation,” she said. “We don’t talk about the intersection of these things. What I’m worried about is that we’re not going to make the same mistakes we made with COVID and pull our communities together.”

Manhattan Borough President Mark Levin, who appointed Salas-Ramirez to the panel, agrees that the city should be prepared for any eventuality. Levine believes the first pediatric case of monkeypox in New York may be imminent.

“We have to be prepared for the possibility that there could be a child or children in New York who get monkeypox,” he said.

When asked about public school safety measures for monkeypox, Levine reiterated that public health facilities are unlikely to have such a method of spreading the virus.

“Health experts say that children are more likely to be infected in households, and less likely to be in schools,” he said. “I haven’t talked to experts who are calling for drastic measures in schools.”

Drastic measures aside, Levine advocates a monkeypox education campaign for everyone, including families with children. It also supports the use of schools as possible locations for testing.

“I think we need to increase our knowledge in the general public about what monkeypox is and how it spreads,” he said. “I think schools need to be willing to be a clear source of information on this first.”

Despite the reported cases among children and pregnant people, public health messages continue to focus on gay and bisexual men. Salas-Ramirez worries that many will use the words to justify their prejudices (one prominent Republican politician has already taken advantage of the opportunity), or that some families who don’t have LGBTQ+ people in their homes might think they’re insensitive.

“I’m worried that monkeypox will be stigmatized and that it’s just gay people who can get the virus,” he said. “It is dangerously divided for people. They don’t think about the public health implications this has on our children.

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