Monkeypox in Children & Is It Possible To Vaccinate Children Against Monkeypox?

The cases of monkeypox have been rising all across the world, with the World Health Organization declaring it a public health emergency. Monkeypox is a disease that is caused by the monkeypox virus. It got its name after being discovered in lab monkeys in 1958. The virus is very similar to the one that causes smallpox, but it usually causes a milder disease and is also less contagious. In the past, monkeypox cases were mostly confined to the region of western and central Africa, in people who recently traveled to these areas, and people who had come in contact with imported or exotic animals. However, in recent months, the virus has been spreading outside of Africa and even showing up in people who have not traveled outside their country or come in contact with any questionable animals.

Your pediatrician will only consider monkeypox in children or adolescents if they present with a rash that is consistent with this disease, especially if other symptoms are also present. Young children, children who have some type of skin condition like eczema, and children who have immunocompromising conditions are known to be at a greater risk of developing the severe disease if they contract the monkeypox virus. ^{(1, 2)}

Historically, though, monkeypox has not been found to affect children drastically. Once infected, though, the symptoms of the disease are more or less similar to that in adults. However, there is no evidence to show whether children are more vulnerable to getting infected with the monkeypox virus than adults. Monkeypox can spread in children if they come in contact with the fluids of people or animals who have monkeypox or through contact with infected items like towels, clothing, bedding, and toiletries. Monkeypox can also be transmitted to the fetus during pregnancy or to a newborn child by close contact with an infected mother during and after birth. However, there is limited data regarding the actual effects of monkeypox in pregnant women.

It is important to keep in mind that data on monkeypox in children still remains quite limited. However, there is evidence from patients infected in the Congo Basin that the disease can be more severe in children under the age of eight years. Additionally, anyone with any immunocompromising conditions or skin conditions like eczema is also at a risk of having severe disease from the infection.

It is rare that monkeypox will cause complications like cellulitis, pneumonia, encephalitis, sepsis, abscess, airway obstruction, etc., in children.

During the 2022 outbreak of monkeypox, the majority of cases have occurred in adult men who have had sexual intercourse with men. However, just like any other viral infection, there are signs that the virus has spread to others. This is why some infections are being observed in children as well.⁽³⁾

There are reports that previous monkeypox outbreaks had increased the mortality and hospitalization rates in children, even in developed countries like the US, where two severe cases in children were reported during the 2003 outbreak of monkeypox, but they both survived.⁽⁴⁾

The symptoms of monkeypox typically begin within three weeks of exposure to the virus. The symptoms include:

• Fever
• Chills
• Swollen lymph nodes
• Muscle ache and backache
• Exhaustion
• Respiratory symptoms
• Rash that progresses from maculopapular lesions to vesicles, pustules, and then finally scabs.

During the current 2022 outbreak of monkeypox in adults, the rash has been commonly found to be located near or on the genitals or anus, but it can also develop on other parts, such as the hands, face, mouth, chest, or feet. Some adults also experience flu-like symptoms and then go on to develop a rash after one to four days. Others may see the rash develop first and then start feeling sick. Some may even only get a rash. It is possible for children also to experience the same symptoms.^{(5, 6)}

Every parent knows that children tend to get a lot of rashes. This is why it is essential for parents to see a doctor if they suddenly see a rash on their child.

Some monkeypox rashes may appear like other virus or bacterial infections or even skin conditions such as chickenpox, herpes, measles, hand, foot, and mouth disease, or even a skin allergic reaction such as eczema.^{(7, 8)}

Experts advise that parents should ideally take a picture of the rash and share it with their pediatrician while also watching its progression. It continues to look the same and does not worsen or start to scab over, it is not likely to be monkeypox. It is also unlikely that the rash is monkeypox if there is no known exposure of your child to the virus or prolonged skin-to-skin contact with a person who has been confirmed to have monkeypox.

While there is a possibility of this happening in daycare or school, it is not very common. It is more likely to mean that the exposure happened within the household or there is a person in the house that has monkeypox, and there was prolonged skin-to-skin contact with the child.

If a child goes to the pediatrician with a rash and fever, also, they are not likely to first get tested for monkeypox without confirming that there has been a known exposure. Just like the isolation measures applicable in COVID-19, children who are infected with monkeypox should also avoid coming in contact with uninfected people and even pets until the rash gets better, the scabs fall off, and preferably a fresh layer of skin has formed.

During the isolation period, the Centers for Disease Control recommends that the lesions should be kept covered in order to prevent children from scratching them and then touching their hands to their eyes. If they get a pox lesion on the eye, this could cause inflammation and scarring of the eye, and it can have an impact on the child’s vision.^{(9, 10)}

Pediatricians also recommend that parents or caregivers should also cover areas of any broken skin with bandages while avoiding skin-to-skin contact with the infected child. They should wear disposable gloves when changing clothes and bandages that cover the child’s rash.

A child with monkeypox needs to stay at home and in isolation. You need to keep them away from other members of the family as well as pets to avoid infecting anyone else. Your pediatrician may advise over-the-counter medicines for pain, itching, or fever. Remember that, as with any other infections, it is important to keep your child well hydrated.

Children who are at a high risk of getting severely sick from monkeypox may be prescribed antiviral medications by the doctor.^{(11, 12)}

There is a vaccine for monkeypox, Jynneos, which has been given permission for emergency use in many countries and may also be recommended for children under the age of 18 years who have been exposed to monkeypox.

Tecovirimat, sold under the brand name Tpoxx, is also available for treating children who are at high risk for severe monkeypox disease, including those under the age of eight years old, who have a history of skin disease, or who are immunocompromised. However, medical experts say that children are more likely to get other rash-causing diseases, such as measles and chickenpox, instead of the monkeypox virus. This is why pediatricians recommend that parents should keep their children’s immunization schedules up to date.⁽¹³⁾

Remember that there are many other vaccine-preventable infections that also cause rashes and fever, and it is best to make sure that your child is up to date with all their routine vaccines.

Smallpox vaccines are also known to be effective against monkeypox infection, and the best preventive action is to make your children learn how to wash their hands properly and often. Masking and avoiding contact with sick people and animals can also help protect your child from falling six.

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Also Read:

• What is Monkeypox & How Long Does it Last? | Causes, Symptoms, Treatment and Prevention of Monkeypox