Below are answers from American Academy of Pediatrics’ experts on some of the most frequently asked questions about how to prevent, recognize, test for, and treat monkeypox in children. Additional resources, including details from Red Book Online, are listed below.
The risk of children getting infected with monkeypox virus is low. As of August 3rd, two pediatric cases have been confirmed in the United States (<0.1% of all cases). Children and adolescents are more likely to be exposed to monkeypox if they live in or have recently traveled to a community with higher rates of infection.
How is monkeypox spread?
Unlike some other rashes, monkeypox remains contagious until the scabs fall off and new skin has formed. Monkeypox can spread to others through close, personal, often skin-to-skin contact, including:
• Direct contact with monkeypox rash, scabs, or body fluids
• Touching objects, fabrics (clothing, bedding, or towels) and surfaces that have been used by someone with monkeypox.
• Contact with respiratory secretions.
Are some kids at increased risk for monkeypox?
Infants, young children (under 8 years of age), children with eczema and other skin conditions, and children with immunocompromising conditions may be at increased risk of severe disease when they contract monkeypox.
What are kids’ symptoms?
Rash is the most common symptom, and it can look similar to other common childhood rashes, like chickenpox, herpes, allergic skin rashes, and hand, foot, and mouth disease.
The rash typically begins as maculopapular lesions and progresses to vesicles, pustules, and scabs. Other common symptoms include fever, lymphadenopathy, fatigue, and headache, but are not always present.
When should I consider having my child tested?
If a child has a suspicious rash, pediatricians should test their patients if there is a history of close, personal contact with someone who has a confirmed, probable case, or travel that puts them at risk.
Testing is available through state public health authorities and at some commercial labs. Requirements for specimen collection and shipping may differ by labs and clinicians should confirm requirements before obtaining a sample from the skin lesions. Monkeypox remains contagious until the rash is fully resolved (scabs fall off and new skin has formed), which can take up to two to four weeks. While contagious, the following precautions should be taken:
Kids’s skin lesions should be covered.
Parents/caregivers should encourage children not to scratch skin lesions or touch their eyes.
Kids with monkeypox should avoid contact with other people and pets. If possible, one person should be the caregiver of a child with monkeypox and should avoid skin-to-skin contact with the rash.
Kids who are at least age two should wear a well-fitting mask when interacting with a caregiver, and the caregiver should wear a respirator or well-fitting mask and gloves when skin contact with the child may occur, and when handling bandages or clothing.
Children should not return to school or childcare while they are contagious. The decision to end isolation and return to school or childcare should be made in collaboration with local or state public health authorities.
What is the guidance for newborns in hospitals who may have been exposed to monkeypox during and/or after delivery?
Infants born to someone with suspected or confirmed monkeypox should undergo early bathing and post-exposure prophylaxis. While the optimal strategy for post-exposure prophylaxis of newborns has not been defined, Vaccinia Immune Globulin should be considered. Infants should also stay in a separate room and not have direct contact with parent (s) or caregivers infected with monkeypox. Breastfeeding should be delayed during the isolation period, and breastmilk should be pumped and discarded.
Is there any treatment for monkeypox for children?
Yes. Treatment is available, particularly for those who have severe disease, are at risk for severe monkeypox disease, (ie, those who are less than eight years of age, those with immunocompromising conditions, those who have a history of certain skin conditions), those who have accidental implantation or lesions in certain anatomical areas (ie. eyes, mouth, genitalia, anus), and children and adolescents with complications from monkeypox.
Tecovirimat is the first-line treatment and is being used under an investigational protocol. The CDC recently streamlined the process to obtain it. It is available in both oral and intravenous forms.
There is currently no monkeypox vaccine available for administration to all children. However, there is a vaccine available to children < 18 years who have been exposed to monkeypox. JYNNEOS vaccine may be recommended for children <18 years of age for post-exposure prophylaxis under a single patient expanded access investigational new drug (IND) protocol through CDC. Clinicians should discuss use of vaccine in a child as post-exposure prophylaxis with the state or local health department and CDC.pox during and after delivery? #
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