Mpox, formerly known as Monkeypox, is a viral disease caused by the Mpox virus, which belongs to the same family of viruses as smallpox. While the 2022 global outbreak primarily affected adults, the virus can infect anyone. Children, especially infants and those with compromised immune systems, are considered a vulnerable population that may experience more severe illness compared to healthy adults.
How Children Contract Mpox
The most common way children become infected is through sustained, close contact within a household setting. This transmission typically involves prolonged skin-to-skin contact with an infected caregiver or family member. The virus spreads through direct contact with a person’s infectious rash, scabs, or bodily fluids, which occurs readily during routine care like cuddling, feeding, or changing diapers.
Transmission can also occur via contaminated objects, known as fomites, which is a particular concern in shared living spaces. Items like bedding, towels, clothing, or dishes that have come into contact with the lesions can harbor the virus. A pregnant person with Mpox may also pass the virus to their fetus during pregnancy or to a newborn during or immediately after birth (vertical or perinatal transmission).
Recognizing Symptoms in Pediatric Cases
The signs of Mpox in children often begin with a prodromal phase that precedes the visible rash. Non-specific symptoms may include fever, headache, body aches, and noticeable swelling of the lymph nodes in the neck or groin area. However, in the recent Clade II outbreak, these systemic symptoms were less consistently observed than in historical cases of the more severe Clade I variant.
The characteristic rash begins as flat, discolored spots (macules) that progress through a distinct series of stages. These spots become firm, raised bumps (papules), then fluid-filled blisters (vesicles), and later pus-filled sores (pustules), before finally crusting over into scabs. Lesions often appear on the face and extremities, but they can also involve the palms, soles, and mucous membranes of the mouth and throat, sometimes making swallowing difficult.
Severity and Risk of Complications
While the majority of Mpox cases in the recent Clade II outbreak have been self-limiting, the disease carries a higher risk of severity for certain children. Infants, particularly neonates under six months of age, and children who are immunocompromised are at the highest risk for a more serious illness. Children with pre-existing skin conditions, such as eczema, are also more vulnerable to a widespread or severe rash presentation.
Specific complications can include secondary bacterial infections of the skin lesions, which may lead to cellulitis. More severe, though less common, complications involve the respiratory system, potentially causing bronchopneumonia, or the central nervous system, which can result in encephalitis. Ocular involvement is also a concern, as lesions near or in the eye can lead to keratitis, risking long-term vision loss. Painful oral lesions can significantly impair a child’s ability to eat and drink, increasing the risk of dehydration, which may necessitate hospitalization.
Prevention and Care Guidelines
Preventing the spread of Mpox relies on isolation and rigorous hygiene practices within the family. An infected household member should isolate from the child until all lesions have scabbed over, fallen off, and a new layer of skin has formed underneath (up to four weeks). To limit indirect transmission, frequent handwashing, cleaning and disinfecting surfaces, and avoiding the sharing of items like towels and bedding are crucial.
For children exposed to an infected person, the JYNNEOS vaccine is authorized as post-exposure prophylaxis (PEP). This two-dose series is administered subcutaneously to high-risk children and adolescents. The vaccine is ideally given within four days of exposure to prevent the disease entirely, but can be given up to 14 days later to reduce symptom severity. For infants under six months, Vaccinia Immune Globulin Intravenous (VIGIV) may be considered instead of the vaccine. Supportive care focuses on maintaining hydration and managing pain, though antiviral treatment may be used in severe cases.