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Kids are going back to school. Experts say monkeypox isn’t a major concern

a child stands outside on playground equipment
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As kids return to the classroom they will also spread germs. But one infectious disease expert says monkeypox isn’t a major concern.

Monkeypox has been found in nearly every state across the U.S. The White House declared it a public health emergency just a few weeks after the World Health Organization designated monkeypox a public health crisis of international concern.

Anyone can get monkeypox through close physical contact and sharing personal items with an infected person. A handful of cases among children have been reported in the U.S., out of nearly 9,000 cases reported so far.

“Monkeypox spreads through close skin-to-skin contact, which – in the case of children – could include holding, cuddling, feeding, as well as through shared items such as towels, bedding, cups, and utensils,” said Kate Fowlie, a spokeswoman for the U.S. Centers for Disease Control and Prevention, in an email.

Back-to-school season is starting, and as kids return to the classroom they will also spread germs. But one infectious disease expert says monkeypox isn’t a major concern and parents should not be alarmed.

To learn more about how to keep kids safe, Side Effects Public Media’s Farah Yousry spoke with Dr. Kristina Bryant, professor of infectious diseases in the department of pediatrics at the University of Louisville School of Medicine.

Could kids going back to school increase monkeypox cases?

As cases spread among adults, more children are bound to get monkeypox, Bryant said, especially if they’re in the same household.

“This virus is spread through close contact, including the kind of close contact that happens in normal households,” she said. “People hug their children and sit on the couch with them. And that's just what parents do.”

But the return to school is not likely to cause a big increase in cases.

Most schools and day cares have protocols for children with rashes, she said, and these protocols help limit the spread of illnesses, including monkeypox. An Illinois day care employee tested positive for monkeypox in early August, but no related cases have been reported.

How can parents best protect their children?

Information about pediatric cases reported in the U.S. is limited. But the CDC said the first two reported cases were likely the result of household transmission.

“One thing parents can do to protect their children is just to be aware of their own health condition,” Bryant said. “Parents who have risk factors for developing monkeypox [who develop symptoms] should be forthright with their child’s pediatrician” and discuss concerns about their child’s potential exposure to monkeypox.

Adults who share a household with young children should try to isolate themselves if they suspect monkeypox exposure or start developing symptoms.

“With monkeypox, people aren't contagious until they develop symptoms. And so we don't need to worry that people are spreading the virus and they don't know it,” Bryant said.

Monkeypox rash can look like a number of skin conditions that affect children, like hand foot and mouth disease or molluscum, or even some allergic rashes or chickenpox, according to the American Academy of Pediatrics.

“All of these are much more common causes of rashes in children than monkeypox. And so, right now, I really don’t think that parents need to be alarmed,” Bryant said.

Bryant also stressed the importance of basic hygiene practices like washing hands and not using other people’s personal items.

What is the CDC’s guidance to providers regarding monkeypox and children? 

Children are not eligible for the monkeypox vaccines, which are in limited supply, unless they were exposed to someone who has monkeypox. The available vaccines work as a preventative measure and also reduce the severity of symptoms post-exposure if given between four and 14 days after exposure, according to the CDC.

There are two FDA-approved vaccines for monkeypox so far: ACAM2000 and JYNNEOS.

The ACAM2000 vaccine is cleared for people of all ages. But the vaccine can have negative side effects for children 12 months or younger and for people with certain skin conditions like eczema and atopic dermatitis and those who are immunocompromised, according to the CDC.

JYNNEOS, on the other hand, seems to have less severe side effects, but is only approved for people 18 years or older.

“But the CDC tells us that that vaccine can be offered to younger children as part of an expanded access investigational new drug protocol,” Bryant said. “And so it's important that physicians who care for children know that any child who's been exposed can be offered this vaccine. Their parents will just need to be educated about the risks and the benefits of the vaccine.”

The treatment TPOXX, or tecovirimat, is also available under special expanded access protocols, the CDC’s Fowlie said. The agency has developed guidance for health care providers about identifying, preventing and treating monkeypox in children and teens.

What do we know about how monkeypox affects children?

Monkeypox has been endemic in some countries in Africa. It was seldom found outside of that geographic area, which is why health experts consider the way the virus has spread there as an indicator of what we may see in the U.S.

Based on cases of monkeypox in Africa, Bryant said there is a concern that young children may be at higher risk for severe disease. That’s particularly concerning for children who have health conditions that compromise their immune systems.

Historically, monkeypox case fatality has been “higher among young children,” according to the WHO. But over the past few months of the outbreak in Europe and the U.S. there have been no reported deaths among children.

It's important to note, Bryant said, that there are two different types of monkeypox viruses, known as clades. The Congo Basin clade is associated with severe illness and has a 10 percent fatality rate, and the West African clade leads to less severe illness with a fatality rate of less than 1 percent. The less-fatal West African clade is circulating in the U.S. now.

When young children have been infected with the Congo Basin clade of monkeypox, Bryant said, they’ve developed severe disease, but “we have less data about the West African clade in children, and that's really the clade that is driving this outbreak.”

What do we know about the risk of monkeypox during pregnancy? 

Based on studies from African countries, some pregnant people who were infected with the Congo Basin clade of monkeypox have suffered pregnancy complications like miscarriage or still birth.

“We know that this virus can potentially cause more severe disease in pregnant women,” Bryant said. “And that's a concern for pediatricians.”

Bryant noted that all this information, however, is mainly based on infections from Africa, and she’s not aware of any severe pregnancy outcomes in the current U.S. outbreak so far.

Still, the CDC recommends that people who are pregnant, recently pregnant, and breastfeeding should be prioritized for medical treatment if needed because of the “probable risk of severe disease…risk of transmission to the fetus during pregnancy or to the newborn by close contact during and after birth, and risk of severe infection in newborns.”

Bryant said that for very young children, including babies born to a mother with an active monkeypox infection, there are some preventative treatments available that can be given on a case-by-case basis.

This story comes from a reporting collaboration that includes the Indianapolis Recorder and Side Effects Public Media, a public health news initiative based at WFYI. Contact Farah at fyousry@wfyi.org. Follow on Twitter: @Farah_Yousrym.

Farah Yousry covers health equity for Side Effects Public Media, in partnership with the Indianapolis Recorder. She can be reached at fyousry@wfyi.org.
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