Children at high risk for monkeypox complications —Study

CHILDREN aged younger than eight years are at an elevated risk for monkeypox complications and should be considered a high-risk group, according to a review article published in The Pediatric Infectious Disease Journal.

Few children have been diagnosed with monkeypox in the current outbreak, with just 83 out of the more than 25,000 U.S. cases reported as of September 24 occurring in people aged younger than 18 years, according to data published this week in MMWR.

The review article was authored by Petra Zimmermann, MD, PhD, a paediatrician and infectious diseases specialist at the University of Fribourg in Switzerland, and Nigel Curtis, PhD, chair of pediatric infectious diseases at the University of Melbourne and Royal Children’s Hospital in Australia, who noted that the global outbreak had included nearly 47,000 laboratory-confirmed cases, but only 211 in children.

This does not mean that the disease hardly affects pediatric patients, they said.

“Children are reported to have an increased hospitalisation rate, even in high-income countries, and an increased mortality,” they wrote. “Children under eight years of age are particularly at higher risk of complications, including bacterial super-infection such as cellulitis, abscesses, pneumonia, and sepsis.”

According to the Morbidity and Mortality Weekly Report ( MMWR) report, among 20 American children aged 0 to 12 years with available exposure data, 19 were exposed in the household setting. For 17 patients, the reported exposure was direct skin-to-skin contact between a child and an adult caregiver. Among 55 adolescents aged 13 to 17 years, an overwhelming 89 per cent were male, and male-to-male sexual contact was noted as the most likely route of exposure.

In terms of treatment, 22 per cent were treated with the antiviral tecovirimat and 11 per cent were hospitalised. The authors also noted that monkeypox occurred disproportionately among Black and Hispanic children and teens.

Zimmerman and Curtis also noted that no authorized monkeypox vaccination exists for children in the U.S., with only Jynneos and the smallpox vaccine ACAM2000 available for use.

“Although [Jynneos] is the only vaccine currently approved by the FDA for the prevention of monkeypox, it has not been licensed or rigorously evaluated in children,” they wrote. “However, since August 2022, the standard vaccine dosing has been authorised for the prevention of monkeypox in children and adolescents down to 1 year of age in the United States under an emergency use authorisation.”

The authors said young children should be considered among those most vulnerable to severe illness due to monkeypox.

“Children (especially those under eight years of age and those with underlying skin conditions), pregnant women and immune-suppressed individuals are considered high-risk groups for whom antiviral treatment with tecovirimat as first-line treatment should be considered,” they continued.

“With increased easing of restrictions because of the COVID pandemic, the paucisymptomatic nature of the current clade, it is possible that the [monkeypox] outbreak could become uncontrolled and spread to more vulnerable patient groups, including children. … Should the current outbreak spread to children, authorities should be prepared to rapidly implement vaccination of this age group.”