Recently, the World Health Organization (WHO) recommended the use of a new preferred term “mpox” as a synonym for monkeypox in response to racist and stigmatizing language occurring online and in some communities during the monkeypox outbreak. Both names will be used simultaneously for one year while “monkeypox” is phased out. Health and Human Services (HHS) and the Centers for Diseases Control and Prevention (CDC) have subsequently adopted “mpox” as the term used to refer to monkeypox disease.
Below are answers from AAP experts on some of the most frequently asked questions about how to prevent, recognize, test for and treat monkeypox (mpox). Additional resources, including details from Red Book Online, are listed below.
Is mpox a risk for children and adolescents?
The risk of children and adolescents getting infected with mpox virus is low. Mpox can spread to anyone through close, personal, often skin-to-skin contact and not through casual contact (eg, in school, child care settings). Risk of infection is more likely for household members and other close contacts of an infected person. As of November 16, 2022, 57 pediatric cases have been reported in children 0-15 years old and 605 cases have been reported in adolescents/young adults 16 to 20 years old in the United States. The highest proportion of cases by race and ethnicity have been reported in people who are White (40%), Hispanic or Latino (18%) and Black or African American (36%).
Are some children and adolescents at increased risk for mpox?
Infants, young children (under 1 year of age), children and adolescents with eczema and other skin conditions and children and adolescents with immunocompromising conditions may be at increased risk of severe disease when they contract mpox.
What are the symptoms of mpox in children and adolescents?
Rash is the most common mpox symptom, and it can look similar to rashes seen more commonly in children and adolescents, including rashes caused by chickenpox, herpes, allergic skin rashes and hand, foot, and mouth disease.
The rash typically begins as maculopapular lesions and then progresses to vesicles, pustules and scabs. Other common symptoms include fever, lymphadenopathy, fatigue and headache, although these symptoms are not always present.
How is mpox spread?
Mpox spreads to others through close, personal, often skin-to-skin contact, including:
- Direct contact with mpox rash or scabs from a person with mpox, including sexual contact.
- Touching objects, fabrics (clothing, bedding or towels) and surfaces that have been used by someone with mpox.
- Contact with large respiratory secretions from prolonged face-to-face contact (this is more of a risk for health care workers, household members and other close contacts of an infected individual).
Unlike some other rashes, mpox remains contagious until the scabs fall off and new skin has formed.
Scientists are still studying whether the mpox virus can be spread in asymptomatic but infected individuals or through body fluids such as semen, vaginal fluids, urine and feces. Mpox is not believed to spread through casual conversations with an infected individual but rather through close contact, that can include sexual encounters.
When should I consider testing a child or adolescent for mpox?
If a child or adolescent has a suspicious rash, pediatricians and other pediatric clinicians should test their patients especially if there is a history of close, personal contact with someone who is a confirmed or 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 laboratory and clinicians should confirm requirements before obtaining a sample from the skin lesions.
If I think a child or adolescent might have mpox, what precautions should I recommend to the family/caregiver?
Mpox remains contagious until the rash is fully resolved (scabs fall off and new skin has formed), which can take up to 2-4 weeks. While contagious, the following precautions should be taken:
- Individuals with mpox should cover their skin lesions.
- Parents/caregivers should encourage their children to avoid scratching their skin lesions and touching their eyes.
- Individuals with mpox should avoid contact with other people and pets. If possible, one person should be the caregiver of a child with mpox and should avoid skin-to-skin contact with the rash.
- Children who are at least 2 years of age who have mpox 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 and adolescents should not return to school or childcare while contagious. The decision to end isolation and return to school or childcare should be made in collaboration with local or state public health authorities.
Is there any treatment for mpox for children and adolescents?
Yes. Treatment is available, particularly for those who have severe disease, are at risk for severe mpox disease, (ie, those who are less than 1 year 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 mpox.
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.
Is there a mpox vaccine indicated for use in children and adolescents and how do I obtain it for my patients?
There is a vaccine available to individuals < 18 years who have been exposed to mpox (ie, JYNNEOS vaccine for post-exposure prophylaxis,) under expanded use authorization issued by the Food and Drug Administration. Jynneos is administered to individuals (age <18 years of age) subcutaneously. The vaccine should not be administered intradermally in individuals <18 years of age. Clinicians should discuss the use of vaccine in a child or adolescent as post-exposure prophylaxis with the state or local health department.
How can I protect myself and other members of the practice team from mpox?
Currently, vaccination is not recommended for most health care workers. CDC recommends that people whose jobs (clinical or research laboratories and certain health care and public health team members) may expose them to orthopoxviruses, such as mpox, receive either JYNNEOS or ACAM2000 vaccine.
Health care workers should utilize the following personal protective equipment (PPE) when caring for a patient with suspected or confirmed mpox infection: gown, gloves, eye protection and N95 (or comparable) respirator.
Is post-exposure prophylaxis recommended for health care workers who have been exposed to monkeypox?
Health care workers who have unprotected, high risk contact with patients with mpox may be eligible for post-exposure prophylaxis in consultation with public health authorities. Post-exposure prophylaxis involves receipt of vaccine, optimally within 4 days of exposure, although it can be given up to 2 weeks from exposure.
What is the guidance for newborns in hospitals who may have been exposed to mpox during and after delivery?
Infants born to someone with suspected or confirmed mpox 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 mpox. Breastfeeding should be delayed during the isolation period, and breastmilk should be pumped and discarded.
- Red Book Online Outbreak: Mpox Virus Outbreak
- What is monkeypox (mpox)? (AAP | HealthyChildren.org)
- Clinical Considerations for Monkeypox(mpox) in Children and Adolescents (CDC)
American Academy of Pediatrics