By: David W. Kimberlin, MD, FAAP & Kristina A. Bryant, MD, FAAP
The United States is among several countries where
cases of monkeypox infections have been reported. The virus causes a rash that can look like
chickenpox (varicella); herpes simplex virus; allergic skin rashes; hand, foot, and mouth disease caused by enteroviruses; or
The United States has classified the current monkeypox
outbreak as a public health emergency. More than 59,600 cases are reported in 103 places around the world. There have been more than 22,700 confirmed cases of monkeypox in the United States. At least 22 U.S. cases have been in adolescents and children age 15 and younger, and 314 cases have been reported in young people age 16 to 20
Monkeypox got its name after the disease was discovered in colonies of monkeys kept for research in the 1950s. It was first discovered in a person in 1970.
How does a person get monkeypox?
Anyone can get monkeypox. The most common way that people spread monkeypox to other people is through
physical contact with the rash or with an object or material (e.g., blankets, furniture, clothes, etc.) that was in contact with the rash. It can also spread through large respiratory droplets from infected people from prolonged face-to-face contact. This is more of a risk for household members and close contacts of an infected person. Monkeypox is not spread through casual conversations with an infected person or walking past an infected person in a grocery store.
A person is contagious from the time symptoms develop until after scabs from the rash fall off and the skin has completely healed.
Anyone who has been in close contact, including sexual contact, with someone who has monkeypox can get the illness. Infections also can spread between people and their
Should I be worried about monkeypox in school or child care?
The risk of monkeypox to children and adolescents in the United States is very low. There have not been many infections in U.S. children and teens, and so far, they have been mild.
Children or staff who get exposed to monkeypox do not need to be excluded from school or child care in most cases, according to the
Centers for Disease Control and Prevention. However, the health department may limit a person's participation in activities if contact tracing is not possible and if there was a high degree of exposure that increased the risk of infection. The health department also will consider the person's age and ability to recognize or communicate symptoms and the risk to others.
Young people may need treatment if their symptoms are severe or if they are at risk of serious illness. Babies and young children under age 8 years; children with eczema, certain skin conditions or other immune conditions; and
pregnant people may be at higher risk of severe disease. The Centers for Disease Control and Prevention recommends that babies stay in a separate room and not have direct contact with parents or caregivers who are infected with monkeypox.
Breastfeeding should be delayed during the infectious period, and breastmilk should be pumped and dumped.
If your child or adolescent had close personal contact with someone with a known or probable case of monkeypox, your child should be monitored for symptoms for 21 days. Steps may include:
Checking your child's temperature daily
Performing daily full-body skin checks for a new rash
Inspecting the inside of your child's mouth for sores or ulcers
Helping their older child or teen with inspection of the mouth and exposed skin areas that may be difficult to see (back of neck, arms and legs)
Reminding your older child or teen to be aware of any rash or pain in areas covered by clothing, including genitals. They should inspect those areas for rash and let you know if they notice any changes in their skin or feel any pain in those areas
Symptoms of monkeypox
The telltale sign of monkeypox virus is how the rash looks and how the spots change over time. When the rash first appears, it looks like flat spots. Classically, all the spots change at the same time, becoming raised bumps and then fluid-filled blisters that become pus-filled white/yellow sores. However, in the current outbreak some patients have had skin lesions that did not follow the usual pattern, appearing in differing stages of development and resolution on a single part of the body. Before the rash appears, early signs may include:
swollen lymph nodes
What if my child or teen has symptoms of monkeypox?
If a child or teen develops symptoms while at home, the parent should contact their pediatrician and the local health department. If they develop symptoms at school or child care, they should:
Be separated from other children or adolescents in a private space (such as an office).
Wear a well-fitting mask (if the child is at least 2 years old).
Be picked up by a caregiver so they can be examined by a pediatrician or other health care professional.
Should my child be tested for monkeypox?
symptoms of monkeypox should talk to their pediatrician or other health care clinician—even if they do not think they had contact with someone who has monkeypox.
Your child may need to be tested for monkeypox if they have a suspicious rash and:
were in close, personal
contact with someone with a confirmed or probable case, or
traveled somewhere that put them at risk of infection.
If your pediatrician suspects monkeypox based on the appearance of rash and your child's history, they will take a skin swab and do a lab test.
Is there any treatment for monkeypox for children?
Most people recover in two to four weeks even without medicines that kill the virus causing monkeypox. Your child may need treatment if they have complications or severe disease, or are at high risk for severe disease. Treatment may be advised if they have lesions on certain parts of their body (for example, eyes, mouth, genitals or anus).
Monkeypox remains contagious until the rash is completely gone---after all scabs have fallen off and new skin has formed. Parents and caregivers of children with monkeypox should:
Cover the child's skin rash.
Remind their child to avoid scratching or touching the rash or eyes.
Keep other people and pets away from the child. If possible, one person should provide all care for them.
Have the child wear a well-fitting mask if they are 2 years old or older when others are taking care of them. The caregiver should wear a respirator or well-fitting mask and gloves when touching the child and handling bandages or clothing.
Keep the child isolated and home from school or other activities until they are no longer
Is there a monkeypox vaccine?
The Centers for Disease Control and Prevention
recommends vaccination for some people who may have been exposed to someone with
monkeypox, including children and teens. The vaccine also may be given to people who work in a laboratory with the virus or provide medical care to infected patients. At this time, there is no need for widespread vaccination of children or most adults. Anyone who has received the monkeypox vaccine from JYNNEOS might consider waiting 4 weeks before they get an mRNA COVID vaccine, especially teen or young adult males who may be at higher risk of myocarditis.
When can someone with monkeypox return to school or child care?
The CDC recommends that anyone with monkeypox should isolate until all scabs from the rash have fallen off, and a fresh layer of healthy skin has formed. This may take as long as 4 weeks after symptoms first started. Caregivers should follow recommendations of their doctor and health department on return to the educational setting.
Should my family worry about monkeypox?
Monkeypox sounds scary, but it is much more difficult to transmit or acquire than COVID. It is always good to be aware of health risks. In the rare event that someone in your household develops monkeypox, share this information with your pediatrician and discuss what you can do to protect your child from infection.
About Dr. Kimberlin
David W. Kimberlin, MD, FAAP, a pediatric infectious diseases specialist at the University of Alabama at Birmingham, is the editor of the
Red Book, the authoritative source for pediatric infectious diseases from American Academy of Pediatrics.
About Dr. Bryant
Kristina A. Bryant, MD, FAAP, a pediatric infectious diseases specialist at the University of Louisville, is the lead for
Red Book Online. She also is the immediate-past president of the Pediatric Infectious Diseases Society.