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Back to School: How to Protect Against Monkeypox


Returning to school is a stressful and exciting time for many people. Still, if you and your family are prepared to safeguard your children against monkeypox, you may hopefully relax into the new school year with confidence.

Steps for back-to-school monkeypox prevention

Scared of monkeypox? You don't need to be. The Centers for Disease Control and Prevention (CDC) feels that the risk to kids in schools remains low. However, parents, teens, and children need to understand what symptoms characterize monkeypox and how to prevent them. Teaching kids what to look for and keeping their distance when a friend, classmate, or teacher isn't feeling well goes a long way towards preventing infection.

  1. Recognize the transmission process
  2. Recognize the symptoms and signs of monkeypox
  3. If a child is exposed, know what steps to take
  4. Monitor kids for 21 days after exposure
  5. Ensure kids do not criticize others if ill; prevent stigmas and exclusions by educating, preventing fear
  6. Due to the restricted availability of vaccines, preventative immunization efforts are not practical. According to the American Academy of Pediatrics (APA), the Jynneos vaccine may be administered to children under 18 once exposed.

Latest Data of Kids Diagnosed with Monkeypox

he CDC and the APA report that children have minimal risk of getting monkeypox. The most recent U.S. data, reported on August 21, 2022, shows that only 17 kids under fifteen have developed monkeypox.

While exposures are notably higher in kids with a recent travel history to regions with higher infection rates. Data for children with the current monkeypox variant (Clade IIB) causing the global outbreak remains limited. The infection risk, though uncertain, remains fairly small, according to experts.

Because the current outbreak appears to most commonly affect individuals through sexual activity networks, the school-aged spread of disease isn't a significant concern. However, as more information comes to light, things could change. So, ensuring your kids remain vigilant and know how to protect themselves remains key.

Are Kids at Risk for Severe Sickness From Monkeypox?

Generally speaking, the disease course for children follows what is seen in adults. However, for some, the risk of complications and more severe disease may occur. Those at higher risk include

  • Infants
  • Kids less than 8 years-of-age
  • Kids with an underlying skin disease - e.g., eczema
  • Kids who are immunocompromised

How do kids become exposed to monkeypox?

Exposure to monkeypox occurs when someone is in close contact with a person with the disease. It can be spread by

  • Direct contact with the rash or skin sores
  • Contact with respiratory droplets (saliva, sneezing, snot)
  • Contact with contaminated objects (doorknobs, faucets, clothing, shared utensils, towels)
  • Sexual contact (oral, vaginal, or anal contact) and any exchange of body fluids
  • Too much face-to-face contact (Hugging, kissing, cuddling, massaging)

Disease in kids and adults can last two to four weeks. During that time, those with the disease remain infectious and capable of spreading it to others. Even the scabs themselves can transmit disease, so a full return to health includes the growth of healthy skin. So, anyone infected needs to be cautious for the duration of the illness.

What Are the Signs of Monkeypox in Children?

Teaching your children to recognize monkeypox symptoms will help kids understand the steps they need to take to protect themselves in school, when participating in afterschool activities, and when socializing with friends and family.

Common clinical signs in kids

A visible skin rash is the most typical indication of monkeypox in the present outbreak. The skin lesions progress from a rash and travel through various stages with open sores, pustules (pimples), and then eventually scab over before new healthy skin regrows. Previous monkeypox outbreaks also commonly saw fever and enlarged lymph nodes (lymphadenopathy). While we see these signs to a degree, it tends to be less so than in previous outbreaks. Various symptoms can also occur related to the position of the sores, including

  • Trouble swallowing or coughing with mouth/nose sores
  • Eye changes like lid swelling or crusting in the eyes
  • Additionally, some may get a headache or be tired

What else can cause a skin rash in school-aged children?

  • Chickenpox (Varicella virus)
  • Hand, foot, and mouth disease (Coxsackieviruses)
  • Measles
  • Allergies
  • Drug reactions
  • Herpes virus
  • Scabies ( a mite, very itchy)

Teaching children the monkeypox signs prepares them to make educated decisions about contact with individuals who demonstrate evidence of illness.

Treating monkeypox in children

Monkeypox has no direct treatments; therefore, prevention is key, and the disease must run its course. Generally, self-limiting (resolving without intervention), some children may be more susceptible to a more serious disease course. However, several things can be done if illness occurs to help ensure your child remains as comfortable and healthy as possible.

For most kids, treatment is primarily TLC

As with adults, monkeypox recovery occurs with tincture of time. For most kids, it will be annoying, and they will have to tolerate the sores as they heal and any other signs that arise. Still, the disease usually resolves on its own. That doesn't mean parents cannot make kids feel more comfortable and address pain, itchiness, or fever with common over-the-counter remedies. Similar therapies used in adults can aid kids in quality of life as they recover from the disease.

Whether your child needs Tylenol or other remedies, treatment must include keeping the sores covered, especially in children. Additional measures include

  • Preventing scratching of the rash and sores
  • Remind kids not to rub their mouth, nose, eyes, and private parts especially with open sores - this could cause additional lesions and worsen the course of the illness; additionally, it can contaminate the environment, exposing bothers
  • Ensure kids remain hydrated
  • Ensure kids continue to eat well
  • Limit contact with uninfected or unexposed people - Isolation ability will depend on the child's age and family dynamics. But ideally, keep the infected away from uninfected family members.
  • Minimize or avoid contact with pets
  • For kids who shave, do not shave areas until all sores have fully healed
  • Have kids over 2 wear a facemask around unexposed individuals to lessen the chance of spread
  • As always, practice proper hygiene – Ensure your child knows when and how to properly wash their hands. Have them clean their hands or use alcohol-based cleaners on non-open skin every time they touch a sore; before they eat or touch their eyes, mouth/face, or private areas; or have them wear disposable gloves if needed to minimize contamination of commonly handled objects like doors, door handles, faucets, and more.

For high-risk kids, any options?

For kids with underlying diseases that stand at an increased risk of severe disease or others at higher risk, options may include

  • An antiviral drug
  • Vaccines if known exposure AKA post-exposure prophylaxis (PEP) – While no vaccines are licensed for use in kids against monkeypox, those at high risk may be eligible for one of the vaccines being used in adults. A risk-benefit assessment helps physicians and parents choose this option when warranted.

My child was exposed: now what?

If exposure occurs, that doesn't mean your child will develop signs of monkeypox. You can take a few steps to monitor them daily and recognize signs, allowing you to remain on top of the disease and get them evaluated asap. Due to the disease course and time of exposure, symptoms can still develop for up to 21 days after contact with someone with the disease. So, the CDC recommends

  • Monitor the temperature of any school-age kids
  • For young kids, check their entire body daily for rashes or other skin changes
  • Check inside the mouth, especially in younger kids who may not recognize the presence of ulcers (sores)
  • For older kids and teens, direct them to check themselves daily but have you assess areas they cannot see or reach, such as the backs of their legs, hands, or arms.
  • Remind older kids to monitor private areas (anus, vulva, penis, testicles) and inform you if concerns
  • Contact your medical professional to determine testing and who else to contact regarding any public health and school concerns, should lesions or signs develop

Keeping kids monkeypox-free

Don't let monkeypox come home from school. Educate your kids. Allow them to understand how the disease occurs and what signs they could develop. Inform them to tell you if they see any sores or rashes on their skin. Have them let you know if they feel run-down or overly tired, have a headache, or something doesn't feel right. Reassure them that admitting illness doesn't make them weak, and no one will judge them for being sick. But, it is important they let you know so that you can prevent others from getting ill and take measures to minimize their disease and keep them comfortable while recovering.

Reassure your kids that monkeypox is unlikely to become an issue in schools and that rashes can happen for various reasons. Let them know you just want them to be vigilant to keep them safe.

Key takeaways

Only 17 children in the U.S. have been diagnosed with Monkeypox as of 8/21/22

School-aged children are at low risk of monkeypox

Monkeypox generally remains self-limiting (resolves over time)

Kids at higher risk for complications may be eligible for antivirals or post-exposure vaccines

References

American Academy of Pediatrics. https://www.aap.org/en/patient-care/monkeypox/

The Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/monkeypox/schools/faq.html

The Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pediatric.html

The Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/monkeypox/if-sick/transmission.html

Medscape Medical News. https://www.medscape.com/viewarticle/979697?reg=1

The Centers for Disease Control and Prevention. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pediatric.html#anchor_1658855976244

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