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Ismail Munir

The monkeypox virus causes monkeypox in children and adults. The symptoms of monkeypox typically go away in 2 – 4 weeks, as explained by experts at Meri Sehat.

Monkeypox In Adults

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Monkeypox In Children

Introduction

Being a parent is not easy, especially during a pandemic. You are left worrying about the safety of your child, often from a disease that is not fully understood. The <a href="https://www.merisehat.pk/disease/covid-19">COVID pandemic</a> brought with it several uncertainties for both adults and children.&nbsp; 
&nbsp;

Although the novel coronavirus was once thought to only cause severe infections in the elderly and adults, cases in children soon became widely prevalent across the world. Moreover, it has been known to cause long COVID and multisystem inflammatory syndrome in children (MIS-C)<a href="#accordion">[1].</a>&nbsp; 
&nbsp;

But COVID is not the only disease that parents are concerned about right now. Several diseases are now causing outbreaks across the world. From hepatitis to <a href="https://www.merisehat.pk/disease/monkey-pox">monkeypox</a>, parents have a lot to look out for.&nbsp; 
&nbsp;

On 23rd July 2022, the World Health Organization declared the ongoing <a href="https://www.merisehat.pk/disease/monkey-pox">monkeypox outbreak</a> a Public Health Emergency of International Concern<a href="#accordion">[2]</a>. As per WHO&rsquo;s estimates, more than 30,000 monkeypox cases have been reported globally since the start of this year<a href="#accordion">[3]</a>.&nbsp;A majority of the cases occurred in the European region, but several other countries have also recorded infections.&nbsp; 
&nbsp;

Researchers believe that the reported number of cases is likely an underestimation as most countries lack surveillance mechanisms and are inadequately equipped to diagnose the infection. The number of cases has been high in non-endemic regions, which is alarming to say the least.&nbsp; 
&nbsp;

While a majority of the cases have had an atypical presentation, with a greater incidence seen among gay men, it occurs in children, too. According to the WHO, more severe infections are seen among children. Furthermore, the case fatality ratio of monkeypox is higher among young children<a href="#accordion">[4].</a> 
&nbsp;

Monkeypox is a zoonotic viral disease that primarily occurs in tropical rainforest areas of Central and West Africa. Monkeys, squirrels, and rats are considered natural hosts of the monkeypox virus.&nbsp; 
&nbsp;

The virus is transmitted to humans whenever there is a close contact with an infected animal or contaminated materials. Human-to-human transmission results from exposure to infected bodily fluids, respiratory droplets, fluid from the lesions, or sharing of bedding and surfaces that are contaminated with the virus.&nbsp; 
&nbsp;

Moreover, the transmission of the virus from the mother to the fetus via the placenta and during birth is also possible.&nbsp; 
&nbsp;

The incubation period for monkeypox ranges from 5-21 days. During the prodromal stage, a person might experience fever, headache, enlarged lymph nodes, muscle aches, back pain, and fatigue.&nbsp; 
&nbsp;

Approximately 1-3 days after the fever, a rash begins to appear on the face, hands, and feet. In 70% of cases, the rash affects the oral mucous membranes; 30% of cases have a rash on the genitals, and 20% on the conjunctivae<a href="#accordion">[4]</a>. 
&nbsp;

The rash initially begins as a flat macule that evolves into a papule (vesicle filled with clear fluid), and then a pustule filled with yellowish pus. Eventually, the pustules will crust and fall off. In severe infections, the skin lesions can merge, causing the skin in the area to slough off.&nbsp; 
&nbsp;

However, the current outbreak has led to atypical symptoms in people. The symptoms include:

<ul>
	<li>Few or just a single lesion</li>
	<li>Absence of skin lesions</li>
	<li>Anal pain and bleeding</li>
	<li>Skin lesions at different stages of development (as seen in chickenpox)</li>
	<li>Skin lesions appearing before the onset of fever and other symptoms&nbsp; 
	&nbsp;</li>
</ul>

Monkeypox is typically a self-limiting disease. However, immunocompromised children might have complications, like secondary infections, pneumonia, sepsis, and a corneal infection causing vision loss and encephalitis.&nbsp;

&nbsp;

Understanding Monkeypox In Children

The signs and symptoms of monkeypox in children are similar to that seen in adults. Fever, swollen lymph nodes, and a rash are common in younger people. The rash looks like a pimple or blister and appears on the face, mouth, or on extremities.&nbsp; 
&nbsp;

Since several other diseases also cause a rash in children, it is possible to confuse monkeypox with other illnesses, including:

<ul>
	<li>Chickenpox</li>
	<li>Hand, foot, and mouth disease</li>
	<li>Measles</li>
	<li>Scabies</li>
	<li>Molluscum contagiosum</li>
	<li>Herpes</li>
	<li>Allergic skin rashes 
	&nbsp;</li>
</ul>

The beginning of a new school year has increased the risk of monkeypox among children. Since the virus can stay in the environment for long periods, contaminated toys and surfaces in school and daycare settings typically lead to further cases among children. Especially in areas where monkeypox cases have been reported during the outbreak.&nbsp; 
&nbsp;

According to the CDC, the following children are at risk of severe disease<a href="#accordion">[5]</a>. 
&nbsp;

<ul>
	<li>Children under 8 years of age</li>
	<li>Immunocompromised children and adolescents</li>
	<li>History of skin conditions, such as eczema or atopic dermatitis</li>
	<li>Children and adolescents with atypical symptoms involving the genitals, eyes, or face</li>
</ul>

&nbsp;

While the majority of monkeypox infections are mild in children, ensure that the lesions are kept covered. Scratching the rash or touching the eyes can spread the infection further and cause more severe illness in children. It is also important to frequently change the bedding if your child is infected.&nbsp; 
&nbsp;

Although most monkeypox cases are self-limiting, severe cases require immediate treatment The CDC recommends tecovirimat for children and adolescents at risk of severe disease<a href="#accordion">[5]</a>. Remember, treatment should only be started after consultation with a doctor. 
&nbsp;

Along with medications, vaccines are also available to protect children who might have been exposed to the virus. The smallpox vaccine has shown to be 85% effective at preventing monkeypox<a href="#accordion">[4]</a>.&nbsp;Recently, the US Food and Drug Administration (FDA) approved the emergency use of the JYNNEOS vaccine in people with a history of exposure to monkeypox and children at high risk of infection<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

The following measures can help protect your child from contracting monkeypox:

<ul>
	<li>Practice frequent handwashing</li>
	<li>Avoid contact with infected individuals or suspected cases</li>
	<li>Stay up to date with other childhood vaccinations</li>
	<li>Get your child vaccinated against monkeypox in case of exposure&nbsp;</li>
</ul>

&nbsp;

Conclusion

Due to a low number of cases from the recent outbreak, there is limited data available on monkeypox in children. Although children can get monkeypox, researchers believe the risk remains low. Moreover, several other diseases can also cause rash in children. However, if you live in a country where monkeypox cases have been reported, it's best to get your child’s rash checked by a pediatrician.&nbsp;

Key Points

<ul>
	<li>Monkeypox is a zoonotic viral disease that results from an infection with the monkeypox virus. Human-to-human transmission results from exposure to infected bodily fluids, respiratory droplets, fluid from the lesions, or bedding and surfaces contaminated with the virus.</li>
	<li>Signs and symptoms of monkeypox include fever, headache, swollen lymph nodes, and a rash that typically begins on the face. In children, the rash resembles a blister or pimple and appears on the face, inside the mouth, or on the hands and feet. However, several other diseases can also cause a rash in children. These include chickenpox, hand, mouth, and foot disease, allergic skin rash, scabies, measles, and molluscum contagiosum.&nbsp;</li>
	<li>Children under 8 years of age with skin conditions such as eczema or those who are suffering from immunocompromised illnesses are at a higher risk of severe infection and complications of monkeypox.</li>
	<li>Monkeypox should be considered in a child presenting with rash, especially if there&#39;s a history of contact with an infected individual, or if one lives in a region with recent monkeypox cases.&nbsp;</li>
	<li>The FDA recommends the use of the JYNNEOS vaccine in adults as well as those under 18 years of age and at high risk of monkeypox infection. Other preventive measures such as frequent hand washing and avoiding contact with confirmed or suspected cases can reduce the risk of infection in children.&nbsp;</li>
</ul>

&nbsp;

[1] Howard-Jones AR, Burgner DP, Crawford NW, et al. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health. 2022;58(1):46-53. doi:10.1111/jpc.15811

[2] Who director-general declares the ongoing monkeypox outbreak a public health emergency of international concern. World Health Organization.

[3] WHO Health Emergency Dashboard. World Health Organization.

[4] Monkeypox. World Health Organization.

[5] Clinical considerations for Monkeypox in children and adolescents. Centers for Disease Control and Prevention.

[6] FDA. Monkeypox update: FDA authorizes emergency use of JYNNEOS vaccine to increase vaccine supply. U.S. Food and Drug Administration.

Nimrah H. Sattar

The <a href="https://www.merisehat.pk/disease/monkey-pox">monkeypox virus</a> was first detected in 1958 in monkeys at a research lab in Denmark. Later, researchers reported the first human monkeypox case in a 9-month-old from the Democratic Republic of Congo (DRC)<a href="#accordion">[1]</a>. 
&nbsp;

Since then, several outbreaks of the <a href="https://www.merisehat.pk/page/sehat-a-z/">disease</a> have been recorded across African countries, including Nigeria, DRC, Sierra Leone, and Liberia. Recently, cases have begun appearing in non-endemic regions such as the United States, the United Kingdom, Israel, and Singapore.&nbsp;

 
In May 2022, multiple monkeypox cases emerged in the UK, mostly in men with no history of travel to endemic regions<a href="#accordion">[2]</a>. They were followed by cases in the United States, Spain, Portugal, and Germany. Since January, a total of 36,412 monkeypox cases and 12 deaths have occurred worldwide<a href="#accordion">[3]</a>, with the majority of cases coming from Europe.&nbsp;

 
As a result, on 23rd July 2022, the World Health Organization (WHO) declared the monkeypox outbreak a Public Health Emergency of International Concern<a href="#accordion">[4]</a>.&nbsp;

 
There are 2 known distinct clades of the monkeypox virus:&nbsp; 
&nbsp;

1. The West African clade&nbsp;

2. The Congo Basin clade&nbsp;

&nbsp;

In the past, the Congo Basin clade had been responsible for more severe infections and considered more transmissible. However, researchers believe the current monkeypox outbreak is caused by the West African clade<a href="#accordion">[5]</a>. This particular clade has a lowercase fatality rate and is less transmissible.&nbsp;

&nbsp;

Understanding Monkey Pox In Adults

Monkeypox is a rare zoonotic disease that results from an infection with the monkeypox virus. Along with monkeys, rats, and squirrels are also natural hosts of the virus. 
&nbsp;

Humans can contract the disease from direct contact with bodily fluids, or skin lesions of an infected animal. The consumption of uncooked meat of an infected animal can also transmit the disease to humans.&nbsp; 
&nbsp;

Human-to-human transmission can occur via: 
&nbsp;

<ul>
	<li>Close contact with skin lesions (during sexual contact, kissing, or even from holding hands)</li>
	<li>Infected respiratory droplets produced during coughing or sneezing</li>
	<li>Contaminated bedding, towels, clothes, or surfaces</li>
</ul>

&nbsp;

<div>The typical symptoms of monkeypox are: 
&nbsp;</div>

<ul>
	<li>Fever</li>
	<li>Severe headache</li>
	<li>Backache</li>
	<li>Joint pain and muscle aches</li>
	<li>Swollen lymph nodes</li>
	<li>Extreme tiredness 
	&nbsp;</li>
</ul>

<div>A rash begins 1-5 days after a fever. It starts as a flat macule and then progresses to a papule, vesicle, and eventually becomes a pustule. These pus-filled vesicles then dry and scab off.&nbsp;</div>

<div>&nbsp;</div>

<div>The rash commonly affects the face, mouth, and extremities. It&rsquo;s often confused with a pimple or a blister, given the monkeypox rash also tends to be itchy or painful. However, the symptoms of the current monkeypox outbreak are different from what were already reported. These include sore throat, epiglottitis, difficulty swallowing, and tonsillitis<a href="#accordion">[6]</a>.&nbsp;</div>

<div>&nbsp;</div>

<div>A recent BMJ study looked at monkeypox cases in London and found many to have atypical characteristics, like penile oedema, genital lesions, rectal pain, and bleeding<a href="#accordion">[7]</a>. Several cases even had a single skin lesion as compared to the thousands that usually appear in a monkeypox infection.&nbsp;</div>

<div>&nbsp;</div>

<div>Another study that analyzed more than 500 patients from across 16 countries found that 73% of the patients had anogenital lesions while 41% had mucosal lesions<a href="#accordion">[8]</a>.&nbsp;</div>

<div>&nbsp;</div>

<div>&nbsp;</div>

According to the NHS UK, a physician should be consulted immediately if the patient has had experienced either of the following<a href="#accordion">[9]</a>:

<ul>
	<li>History of contact, including sexual contact, with a suspected monkeypox case in the past 3 weeks</li>
	<li>One or more new sexual partners in the past 3 weeks</li>
	<li>History of travel to the West or Central Africa in the past 3 weeks&nbsp;</li>
</ul>

&nbsp;

Direct skin-to-skin contact with lesions is one of the primary modes of transmission. In the current outbreak, a majority of cases in the European region occurred in gay, bisexual, and other men who have sex with men (MSM)<a href="#accordion">[2]</a>. This is similar to the 2017 monkeypox outbreak in Nigeria where a large number of cases presented with genital ulcers[<a href="#accordion">10]</a>. Thus, there is strong evidence that suggests monkeypox is also sexually transmitted.&nbsp; 
&nbsp;

However, despite researchers detecting monkeypox virus DNA in semen samples<a href="#accordion">[11]</a>, there is no clear evidence of the virus transmitting via sexual intercourse. Then again close skin contact during sexual intercourse might play a role in monkeypox transmission so, doctors advise caution against any form of close contact with people with an unexplained rash.&nbsp;

&nbsp;

Treatment for monkeypox includes symptomatic management as the disease is mostly self-limiting. However, in the elderly, children, and immunocompromised individuals there is a risk of severe infection and complications. In these cases, doctors prescribe the antiviral tecovirimat. Moreover, high-risk individuals with a history of exposure are administered a vaccine for post-exposure prophylaxis.&nbsp; 
&nbsp;

The smallpox vaccination is considered 85% protective against monkeypox infection<a href="#accordion">[12]</a>. Newer vaccines are now also available for preventing the disease. However, they are limited in quantity. Therefore, the best strategy is to practice prevention measures, such as regular handwashing, avoiding contact with suspected or confirmed cases, and looking out for any new rash.&nbsp;

Any new or unexplained rash needs to be assessed by a healthcare professional, regardless of one&rsquo;s sexual orientation. In case anyone is diagnosed with monkeypox, avoid close contact with others (quarantine, if possible) until the skin lesion is completely healed.&nbsp;

&nbsp;

<ul>
	<li>Monkeypox is a zoonotic viral disease that is endemic in Central and West African regions close to tropical rainforests. The virus spreads to humans through close contact with infected animals or contaminated objects.&nbsp;</li>
	<li>Human-to-human transmission can occur via exposure to infected bodily fluids, skin lesions, respiratory secretions from an infected individual, and contaminated materials.</li>
	<li>A rash typically begins 1-5 days after a fever. It may be itchy and painful and initially resemble a pimple or a blister. While the rash commonly affects the face, mouth, and extremities, there have also been cases of genital lesions, anal pain, and rectal bleeding.&nbsp;</li>
	<li>Moreover, a sore throat, epiglottitis, tonsillitis, and difficulty swallowing might occur among patients.&nbsp;</li>
	<li>There is no concrete evidence of monkeypox being a sexually transmitted disease, but researchers advise avoiding sexual contact if one has a rash as intimate contact can cause exposure to blister fluid and transmit the disease among people.&nbsp;</li>
	<li>Any new or unexplained rash should be assessed by a healthcare professional, regardless of one&rsquo;s sexual orientation. In case anyone is diagnosed with monkeypox, take precaution and avoid close contact with others until the skin lesion is completely healed.&nbsp;</li>
	<li>People with a recent history of travel to Africa should be on the lookout for monkeypox symptoms. Especially if they have had a new sexual partner in the past 3 weeks.&nbsp;</li>
</ul>

&nbsp;

[1] Ladnyj ID, Ziegler P, Kima E. A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo. Bull World Health Organ. 1972;46(5):593-597.

[2] Monkeypox cases confirmed in England – latest updates. GOV.UK

[4] WHO director-general declares the ongoing monkeypox outbreak a public health emergency of international concern. World Health Organization.

[5] Guarner J, del Rio C, Malani PN. Monkeypox in 2022—what clinicians need to know. JAMA. 2022;328(2):139. doi:10.1001/jama.2022.10802

[6] del Rio C, Malani PN. Update on the Monkeypox outbreak. JAMA. 2022. doi:10.1001/jama.2022.14857

[7] Patel A, Bilinska J, Tam JC, et al. Clinical features and novel presentations of human Monkeypox in a central London Centre during the 2022 outbreak: Descriptive case series. BMJ. 2022. doi:10.1136/bmj-2022-072410

[8] Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022 [published online ahead of print, 2022 Jul 21]. N Engl J Med. 2022;10.1056/NEJMoa2207323. doi:10.1056/NEJMoa2207323

[9] Monkeypox. NHS choices.

[10]  Ogoina D, Izibewule JH, Ogunleye A, et al. The 2017 human monkeypox outbreak in Nigeria-Report of outbreak experience and response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. PLoS One. 2019;14(4):e0214229. Published 2019 Apr 17. doi:10.1371/journal.pone.0214229

[11] Lapa D, Carletti F, Mazzotta V, et al. Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding. The Lancet Infectious Diseases. August 2022. doi:10.1016/s1473-3099(22)00513-8