Monkeypox in Children: What Parents Need To Know About the Risks

In recent days and weeks, the monkeypox outbreak has become increasingly widespread and concerning. The latest numbers from the Centers for Disease Control and Prevention (CDC) put the confirmed case count at about 5,189 in the United States and more than 22,000 globally, prompting the World Health Organization (WHO) to declare the virus a public health emergency of international concern.

Two cities in the United States have have also just declared public health emergencies and the Biden Administration is considering doing the same. The latest developments also include two children contracting the virus, news that likely has parents wondering how much of a risk monkeypox actually poses.

The two cases included a toddler in California and an infant from the United Kingdom whose family was visiting the United States. The CDC has said both infections are likely due to household transmission.

Still, this news can be unsettling for parents as this latest global health scare continues to evolve. Here's a closer look at what experts have to say about transmission of monkeypox among young children and whether this outbreak is cause for concern.

Monkeypox Transmission To Children

Though children, like anyone, can get monkeypox, they are very unlikely to be at risk right now. Having just two children identified out of thousands of cases means that at least for now, parents shouldn't be overly concerned about children becoming infected. Children still make up a very small fraction of cases globally and in the US.

"Out of the 15,000 cases that have been reported to WHO, about less than 75 have occurred in children," Aniruddha Hazra, MD, an infectious disease physician and assistant professor of medicine at the University of Chicago, told Health. "And so while…certainly we're seeing potential cases in children, I do not believe at this point children are really a primary risk group for this virus."

In the majority of instances, monkeypox spreads through close skin-to-skin contact. The current outbreak is spreading mostly through intimate contact between men who have sex with men, said Hazra. In the United States, 95% or more of confirmed infections have been in men who have sex with men. While, anyone can get monkeypox, for now, cases in this country have been largely limited to these networks.

The two reported cases in children both seem to have come from household transmission. There are many ways this could happen—including through cuddling, or touching items such as clothing or linens, for instance, according to the CDC.

There are a few other ways of transmitting monkeypox, though they are less common. It could spread through droplets or "contact with contaminated clothes, bedding, furniture and possibly other shared items," Karen Edwards, Ph.D a professor of epidemiology and biostatistics at the University of California Irvine program in public health, told Health. However, Edwards added, "the majority of infections are due to direct contact with someone with an active rash."

At the moment, children do not seem to be getting monkeypox through contact in public places, such as pools and changing rooms. This too may be due to the fact that the virus usually requires intimate, prolonged contact to spread. It also indicates that children are unlikely to get the virus at school, said Dr. Hazra.

Monkeypox Symptoms and Risks

Children under 8 years old are at greater risk of having severe symptoms from monkeypox, according to the CDC, though in general monkeypox symptoms during this outbreak have been mild. The most distinctive symptom is the characteristic pimple-like rash, but additional symptoms include fever, headache, muscle aches and backache, swollen lymph nodes, chills and exhaustion. The virus can also trigger respiratory symptoms such as a sore throat, nasal congestion, or cough, according to the CDC.

As with other diseases, neonates, or extremely young children in their first weeks of life, are likely vulnerable because of their weaker immune systems.

"They're probably going to be at risk for severe disease," Carl Abraham, MD an assistant professor of clinical sciences at the New York Institute of Technology College of Osteopathic Medicine told Health. However, he said, it's hard to know for sure because of the small number of confirmed cases in children during this outbreak.

No deaths from the virus have been reported in the US, however, but five people in African nations have died of the virus.

Vaccines and Treatments

The two children who were infected with monkeypox have been reported to be doing well and are receiving treatment with an antiviral medication called TPOXX. While there are no treatments specifically for monkeypox, TPOXX is a treatment for smallpox which studies show is safe to give to healthy people and which may cause only minor side effects. Because children under eight are at greater risk, the CDC recommends this treatment for kids.

Children who were—or might have been—exposed to an individual with monkeypox may be able to get a vaccine called JYNNEOS, which the CDC said is being made available to children through expanded use protocols. JYNNEOS is approved by the FDA to protect against smallpox and monkeypox. Currently, however, vaccinations strategies are prioritizing men who have sex with men, who make up the vast majority of cases, said Dr. Hazra.

The vaccines "are currently being distributed among populations that we are seeing the highest rates of monkeypox in...just like the COVID vaccine was prioritized for certain populations at the very beginning," said Dr. Hazra.

Do's and Don'ts

If your child develops symptoms that you suspect could be monkeypox or your child was directly exposed to someone with monkeypox, the best course of action is to call their pediatrician, Andrea Berry, MD, a pediatric infectious diseases specialist at the University of Maryland Medical Center and an associate professor of pediatrics at the University of Maryland School of Medicine, told Health.

A pediatrician can order the appropriate tests for your child and alert state and local public health agencies to the child's case. Anyone, child or otherwise, who thinks they could have been exposed should isolate until everything is sorted out, Dr. Berry said.

You should also keep up to date on information about monkeypox, as the situation could change rapidly. Dr. Berry recommends regularly visiting the CDC and WHO websites for updated information. Yet another option is the Vaccine Education Center website, which is part of the Children's Hospital of Philadelphia, for updated information on vaccinations.

While there is nothing in particular that parents should avoid doing with children, it is a good idea to engage in regular hand-washing, mask-wearing, and other habits used to prevent diseases like COVID-19, said Dr. Hazra. In fact, at this point, it is far more likely that a child will get COVID-19 than monkeypox, added Dr. Hazra.

What parents should not do, however, is panic.

Monkeypox "is something we all need to pay attention to as everyone is potentially susceptible," Edwards told Health. "But parents should not worry excessively about their children contracting monkeypox."