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What pediatricians need to know” about monkeypox in children
Children 8 years old or younger should be considered a high-risk group for more severe monkeypox disease, reports The Pediatric Infectious Disease Journal, the official journal of the European Society for Pediatric Infectious Diseases. The journal is published in the Lippincott portfolio of Wolters Kluwer. Young children would be an important target group for smallpox vaccination and other urgent interventions if the outbreak expands, according to the review by Petra Zimmermann, MD, PhD, of the University of Fribourg, Switzerland, and Nigel Curtis, PhD, of the University of Melbourne and Murdoch Children's Research Institute, Australia. They provide an expert perspective on “What Pediatricians Need to Know”…
What pediatricians need to know” about monkeypox in children
Children 8 years old or younger should be considered a high-risk group for more severe monkeypox disease, reports The Pediatric Infectious Disease Journal, the official journal of the European Society for Pediatric Infectious Diseases. The journal is published in the Lippincott portfolio of Wolters Kluwer.
Young children would be an important target group for smallpox vaccination and other urgent interventions if the outbreak expands, according to the review by Petra Zimmermann, MD, PhD, of the University of Fribourg, Switzerland, and Nigel Curtis, PhD, of the University of Melbourne and Murdoch Children's Research Institute, Australia. They provide an expert perspective on “What pediatricians need to know” about monkeypox in children.
Previous outbreaks raise concerns about the risks of monkeypox in young children
As of August 2022, nearly 47,000 laboratory-confirmed cases of monkeypox have been reported worldwide. Of these, only 211 were among children and young people under the age of 18. In the current outbreak, the monkeypox virus appears to have spread largely through sexual or other close contact. The role of other routes of transmission, including via droplets and contaminated surfaces and objects, remains to be determined.
The outbreak reflects low population immunity due to low vaccination rates against smallpox; Smallpox and monkeypox viruses are both orthopoxviruses. Most cases of monkeypox are “self-limited,” with a rash that progresses and disappears within 2 to 4 weeks. However, symptoms may be mild or absent, leading to misdiagnosis and the possibility of further spread.
Despite the low reported rates in children to date, there are particular concerns about complications and other serious consequences of monkeypox in children. “Children are reported to have increased hospitalization rates and mortality even in high-income countries,” said Dr. Zimmermann and Curtis write. Based primarily on data from low-income countries, children under 8 years of age are particularly at higher risk of complications, including potentially serious bacterial infections. Young children may also be at increased risk of complications related to scratching and spreading the infection to other parts of the body, including the eyes.
Most patients with monkeypox recover with supportive care. However, more specific treatment is required for severe cases and at-risk groups - particularly children under 8 years old and those with underlying skin conditions. Other groups at risk include pregnant women, immunocompromised patients and people with eczema or monkeypox rash near the mouth, eyes and genitals.
In these high-risk cases, treatment options include antiviral drugs such as tecovirimat, which is active against orthopoxviruses; and vaccinia immune globulin (VIG), used to treat complications of smallpox vaccination. “None of these treatments have been shown to be effective against monkeypox virus in humans in clinical trials, and they are currently recommended only after consultation with national health authorities,” the reviewers write.
Smallpox vaccination is effective in preventing monkeypox, although the duration of protection is unknown. Because routine smallpox vaccination stopped after smallpox was eradicated in the United States in 1972, many people were never vaccinated. A new type of vaccine (MVA-BN) has been approved by the FDA to prevent monkeypox, but has not been “approved or rigorously evaluated” in children.
For children exposed to the monkeypox virus, medications or vaccines to prevent monkeypox have been recommended, again with “very limited data.” The reviewers also discuss some special considerations for pregnant/breastfeeding women and newborns of infected women.
Because monkeypox can be asymptomatic, the outbreak could become uncontrolled and spread to vulnerable groups, including young children. In this case, “additional urgent steps” are required – with the smallpox vaccine playing a crucial role. “The smallpox vaccination offers protection against monkeypox,” says Dr. Zimmermann and Curtis conclude. “Should the current outbreak spread to children, authorities should be ready to quickly implement vaccination of this age group.”
Source:
Reference:
Zimmermann, P., et al. (2022) Monkeypox – What pediatricians need to know. The Journal of Pediatric Infectious Diseases. doi.org/10.1097/INF.0000000000003720.
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