Monkeypox risk higher in children 8 or younger: research

According to the review by Petra Zimmermann, MD, Ph.D., of the University of Fribourg, Switzerland, and Nigel Curtis, Ph.D., of The University of Melbourne and Murdoch Children's Research Institute, Australia, young children would be a key target group for smallpox vaccination and other urgent measures if the outbreak widens.

They offer a professional viewpoint on "What doctors need to know" about childhood monkeypox.

Past outbreaks

Past outbreaks raise concerns about monkeypox risks in young children. About 77,000 monkeypox cases with laboratory confirmation had been reported globally, from 47,000 of August 2022.

Only 211 of these were in children and adolescents under the age of 18. The monkeypox virus appears to have been transmitted most widely in the present outbreak through close contact. It is still unknown how other transmission pathways, such as droplets and contaminated surfaces and objects, play a part.

Smallpox and monkeypox viruses are both orthopoxviruses, and the epidemic is a reflection of inadequate population immunity as a result of low rates of smallpox immunization. The majority of monkeypox cases are "self-limiting," with the rash developing and going away in 2 to 4 weeks. However, the absence or mildness of the symptoms might lead to missed diagnoses and the possibility of future spread.

Complications

Despite the low reported rates in children so far, there are special concerns about complications and other serious outcomes of monkeypox in children.

"Children are reported to have an increased hospitalization rate and increased mortality, even in high-income countries," Drs. Zimmermann and Curtis write.

Based mainly on data from low-income countries, children under 8 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.

With supportive care, the majority of monkeypox patients will recover. For severe cases and high-risk groups, such as children under 8 years old and people with underlying skin disorders, more specialized care is required.

Pregnant individuals, immunocompromised patients, those with eczema, and those who have monkeypox rash around the mouth, eyes, or genitalia are additional risk populations.

Antivirals

Antiviral drugs such as tecovirimat, which is effective against orthopoxviruses, and vaccinia immune globulin (VIG), which is used to treat side effects of smallpox vaccination, are therapy choices in these high-risk situations.

However, "None of these treatments have been proven to be effective against monkeypox virus in humans in clinical trials, and they are currently only recommended after consultation with national health authorities," the reviewers write.

Although the length of protection is unknown, the smallpox vaccine is effective in preventing monkeypox. Many people have never received a smallpox vaccination because the practice was abandoned when the disease was declared eliminated, which occurred in the United States in 1972.

New monkeypox vaccine

The FDA has approved a new vaccine (MVA-BN) for the protection of monkeypox, although children have not been "licensed or carefully studied" with it.

Again, there is "very limited data" to support the use of drugs or vaccines to prevent monkeypox in children who have been exposed to the virus. The reviewers also go through certain unique issues for expectant mothers, nursing mothers, and babies born to infected mothers.

Monkeypox can be asymptomatic, thus the outbreak could get out of hand and affect vulnerable populations like young children. The smallpox vaccine would be essential, and "extra urgent steps" would be required in that situation.

Drs. Zimmermann and Curtis conclude that smallpox vaccination provides protection against monkeypox. Authorities should be ready to rapidly adopt immunisation of this age group if the present outbreak expand to youngsters.

Wolters Kluwer publishes the journal under the Lippincott imprint.

Immunocompromised 

People with severely weakened immune systems, such as those infected with HIV, can experience severe symptoms and even die from a monkeypox infection, according to a US study released on October 26, 2022.

The study looked at cases of 57 US patients hospitalised with severe monkeypox complications. Almost all (83%) had severely weakened immune systems, most often because of infection with the human immunodeficiency virus (HIV). Many of those patients were not being treated for the virus that causes AIDS.

Just over 28,000 people in the United States have been infected with monkeypox since the start of the outbreak in May. Cases in the United States started peaking in mid-August and have since dropped sharply, helped by the rollout of vaccines.

Deaths outside of Africa, where the virus is endemic, are rare, as are deaths caused by the form of the virus now circulating in the United States - Clade IIb.

Overall, it found that 47 of these individuals were also infected with HIV, yet only four of them were receiving antiretroviral therapy, powerful drugs that keep the virus in check. Most (95%) were male, and 68% were Black.

Analysis

According to the analysis, 17 patients required care in an intensive care unit, and 12 have died, including five in which monkeypox was a contributing factor or the confirmed cause of death.

The researchers urged healthcare workers to test all sexually active patients with suspected monkeypox infections for HIV at the time of monkeypox testing, unless the patient's HIV status is already known.

For those with suspected monkeypox infections who test positive for HIV, the CDC urged providers to start the patient on monkeypox treatment as soon as possible, potentially even before monkeypox infection is confirmed.

The agency also recommended that doctors start HIV treatment for those who test positive for that virus as soon as possible.