• Two children have been identified as having monkeypox in the United States.
  • Children under 8 years old may be at increased risk for severe outcomes of the virus.
  • Monkeypox has spread mainly through close contact. Respiratory transmission is less common.
  • The vast majority of cases have been in adults.

Monkeypox cases are spreading mostly among adults, but two cases in pediatric patients in the U.S. may have made many parents concerned about the risks for children.

The two new cases of monkeypox in children have been identified in a toddler from California and an infant who is not a US resident but was tested while in Washington, DC. These unrelated and isolated patients are secondary to household transmission or when someone else in the home unintentionally passes it along to a child.

So far the disease, which spreads through close contact, has spread almost exclusively among adults.

Although the most common way to get monkeypox in this outbreak has been through intimate contact, it is possible to get this condition through close contact such as a parent hugging or kissing a child. It is the close contact that matters most in disease risk.

Gay and bisexual men have been the group most likely to develop the disease at this point. The disease spreads primarily through close contact.

Dr. Anthony Fauci, chief medical adviser to the White House, said in an interview with NPR this week, that it was important to get control of the virus soon so that it does not spread more widely.

“We need to get our arms around understanding just the extent of the spread, how it’s spread, what population,” he said. “Right now it’s focused – because it’s about 99% – among men who have sex with men. We’ve got to understand the modality of transmission, the manifestations, also the risk for people like children and pregnant women. There’s really a profound risk.”

The Centers for Disease Control and Prevention has determined that children under the age of eight may be at an increased risk for severe outcomes from monkeypox if they develop the disease. This is likely due to a less developed immune system.

Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, Tennessee, says that these cases can teach us more about monkeypox.

“We can learn from these rare cases as investigating how these children got this infection can tell us more about the ways monkeypox can spread,” Schaffner told Healthline.

It is believed that the symptoms of monkeypox in children are the same as adults.

While there are not many details regarding these two children or how it spread to them, the virus has likely spread through close contact such as a parent or guardian hugging or kissing as direct contact with lesions. Although less common, respiratory transmission is also possible.

“The illness typically begins with flu-like symptoms – fever, headache, sore throat, cough – and within a few days the rash will appear,” says Dr. Shannon Ross, Associate Professor at the University of Alabama at Birmingham’s Division of Pediatric Infectious Diseases.

“The lesions appear as bumps that become fluid-filled sores located on the face, arms, legs, and hands. If a person was infected during sexual contact, the lesions could appear on the genitals,” Ross tells Healthline.

However, not all these symptoms will be present, and in some cases, people may only experience a rash throughout their body.

The WHO recently determined that monkeypox is now a global health emergency, according to Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO.

The last time this designation was given to an illness was on January 30, 2020, with COVID-19.

Despite this label, this does not mean the virus is deadly, but rather a virus that is quickly spreading throughout multiple populations throughout the world.

Cases throughout the country have been rising steadily with almost every state now having confirmed cases of monkeypox. Most recently, the CDC reports over 4,900 cases in the United States – a number that has quickly increased over the past several weeks.

“As the number of cases of monkeypox are increasing, it is not a surprise that we are now seeing cases in children, and although more cases are being reported, it remains uncommon and the risk of acquiring it is low, so we do not need to be worried,” said Ross.

Among these thousands of cases, only the two cases in California and Washington D.C. have been identified in children.

While it is theorized that the vaccine can be efficacious and available for children, there is currently no protocol for its use in this population. The vaccine has been reserved for adults who have either been exposed to or are in high-risk situations.

Despite many people wanting the vaccine, it is not as readily available as some would like. Many government officials have asked for additional vaccines – including in New York, which leads the country in the highest number of cases.

Dr. Ashish Jha, the White House COVID-19 Response Coordinator, recently stated that there will be a release of “hundreds of thousands of more vaccines in the next days and weeks” in a recent interview on “Face the Nation.” Despite an increased release of the vaccine, it is unlikely that children will be receiving this vaccine as they are not the primary population for contracting this virus.

“These vaccines are currently being used as a post-exposure treatment instead of prevention,” says Schaffner.

“There are so many adults, the vastly more common population who gets this virus, that could use this vaccine well before children as this illness remains quite rare in younger populations.”

Health and Human Services Secretary, Xavier Becerra, said in a statement that FDA has approved the use of an additional 786,000 doses of the vaccine which are going to be available for use in the United States.

While not officially approved for monkeypox, the antiviral medication Tecovirimat, or TPOXX, has been used in vulnerable populations who have contracted monkeypox, including children.

It has been reported that the two children who have tested positive for monkeypox are currently being treated with TPOXX.

Despite having monkeypox, Rochelle Walensky, Director of the CDC, notes that “the children are doing well,” in a live interview on July 22.

“Most cases of monkeypox are mild and self-limiting and resolve without treatment,” Ross tells Healthline.

Although these medications are available for use in children and adolescents, Ross says they are for those with “severe disease or an underlying medical condition that puts them at risk for severe disease.”

While there have been cases of monkeypox in children, this is not a reason to be concerned. This virus has so far been non-lethal even as cases have increased globally and virtually all cases have been in adults.

Those most at risk of disease include gay, bisexual, and other men who have sex with men populations. The virus spreads through close contact, which includes but is not limited to sexual contact.

“There are a number of questions on the spread of this virus, and one of the investigative points we can learn from these infected children is how it spreads in a variety of ways – sometimes before the rash has appeared – and that information can help slow down the progression of this illness,” says Schaffner.

Rajiv Bahl, MD, MBA, MS, is a board-certified emergency medicine physician and health writer. You can find him at RajivBahlMD.com.


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