The US gov just declared monkeypox a public health emergency, and as cases continue to rise, (and with five children getting monkeypox in the US so far), we phoned an expert. Dr. Vandana Madhavan is a primary care pediatrician and the clinical director for the pediatric infectious disease division at MassGeneral Hospital for Children. She talked to us about the outbreak, what to know about monkeypox in kids, and how to keep your family safe.
The biggest takeaway: If your child does get monkeypox, they will most likely be able to recover at home (more on that below). Dr. Madhavan said there’s no need to rush to an emergency room if you spot a rash. Instead, call your pediatrician and ask what you should do. (Reminder: health care workers will need protective equipment and to put protocols in place to prevent an infected person from spreading monkeypox to others).
“I'm still more worried about COVID than monkeypox right now. Let's put it that way. But of course, I'm following monkeypox and want to know how things are evolving and how things are changing in terms of recommendations,” said Dr. Madhavan.
Is monkeypox on track to spread at the rate that COVID did?
Short answer: Not right now.
Monkeypox spreads through direct contact with the rash, scabs, or respiratory droplets of an infected person usually through close, intimate contact like cuddling, kissing, or sex. The virus can also spread by touching or sharing infected items like clothing and bedding. (Reminder: COVID spreads when an infected person breathes out droplets with the virus.)
“This is not an airborne virus. It isn't like someone with monkeypox gets into a crowded room and everyone there is exposed. You really need prolonged close contact,” said Dr. Madhavan. “But of course, viruses evolve. And so we need to keep following and learning more about this particular strain.”
Monkeypox symptoms in kids are the same as in adults (think: fever, muscle aches, headache, and a rash). Dr. Madhavan said there’s limited data from this current outbreak since only a few cases have been confirmed in kids.
Which kids (and age groups) are most at risk?
Dr. Madhavan said in African outbreaks, children under eight were at greater risk of having complications. But she said it was too early for US officials to definitely say whether children are at greater risk.
“We're still learning,” said Dr. Madhavan. “Is it something to do with just more immature immune systems? Is it due to potential other infections or underlying conditions that other children might have?”
Thing to (also) know: Kids with underlying immunodeficiencies could also be at greater risk.
What monkeypox treatments are available if my kid gets it?
Most cases will require isolation until symptoms are gone (2-4 weeks) and at-home treatments (aka: meds for fever, pain, or itchiness from a rash).
“[It’s] similar to chickenpox. With monkeypox if they are sick, you wait until all of the rash lesions have crusted over and there are no active symptoms,” said Dr. Madhavan.
But if your child is having trouble breathing or is at high-risk for complications, there are antiviral medications (hi, TPOXX) only available at the hospital. They could also get immune globulin, an antibody treatment. Neither is approved by the FDA to treat monkeypox. And your child would have to be admitted to the hospital and monitored. Dr. Madhavan explained that none of the current treatment options were made to directly target monkeypox. They’ve been used for other viral infections, like smallpox (monkeypox’s deadlier cousin).
Dr. Madhavan said deciding whether to use these medications would be a case-by-case basis (and of course, would come down to your doctor’s recommendation).
If I want to vaccinate my child against monkeypox, where could I go?
TBA. The FDA-approved vaccine for monkeypox (called Jynneos) is currently for adults only. But Dr. Madhavan said it could be considered for children on a patient-by-patient basis as part of an investigational drug protocol.
“We'd have to have a few different criteria be met before [the monkeypox vaccine] opens up to the general public. We'd have to really be able to say that based on how this virus is acting, how it's being transmitted, what kind of illness it's causing and in whom, that children are at greater risk and therefore need additional protection. But also we'd have to have enough data in children to be able to say the Jynneos vaccine is not just effective, but safe as well in children,” said Dr. Madhavan.
Can you have monkeypox more than once?
Dr. Madhavan said there isn’t enough information yet to know how monkeypox antibodies work and how long they last to protect from reinfection.
Is it safe for my child to go back to school with monkeypox cases on the rise?
One word: Yes.
“One thing to keep in mind that’s different with monkeypox than with other infections is that you aren't contagious until you have symptoms,” said Dr. Madhavan. “If people say, ‘Hey, I'm feeling sick. I am not gonna go to school, to work, to visit family, to visit friends, and stay home.’ That's gonna limit the spread. And so we're less worried about the presymptomatic or asymptomatic spread.”
How can I prevent my child from getting monkeypox?
You don’t have to bring the masks back out — at least not for monkeypox. Dr. Madhavan said to look out for symptoms (remember: fever, muscle aches, headache, and a rash) and ask family members and friends to stay away if they’re sick — a good rule for any sickness.
“As a pediatrician, one of my goals is to empower parents to do what's best for their children [by asking] questions,” said Dr. Madhavan. “In terms of protecting [children] from monkeypox, it's [parents] asking questions like, ‘Hey, have you been sick? Any reason that we need to think about COVID, monkeypox, flu, whatever? Has anyone been exposed? Should we still go ahead with these plans?’”
If you’re pregnant and get monkeypox, can you pass it to your baby?
“[Based on] past outbreaks, [we] know that pregnant women who are infected with monkeypox can transmit the virus through the placenta to babies who can then be infected. It can cause pregnancy complications, but [we have] very limited information,” said Dr. Madhavan.
We’re all dreading another public health crisis. But monkeypox doesn’t spread as easily as COVID-19 because it’s not an airborne virus. And if your child does get infected, experts recommend taking the same precautions we’ve gotten all too familiar with in the past couple of years: isolate, monitor, and wait it out.
Updated on Aug. 4 after US gov declared health emergency.
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