It is fortunate that, in the recent mpox (formally known as monkeypox) outbreak, there have been fairly few pediatric cases.
However, that means that there is very little information about pediatric mpox.
I was therefore eager to read a Start of the Art Review by a team from the CDC led by Dr. Amy Beeson, entitled “Mpox in Children and Adolescents: Epidemiology, Clinical Features, Diagnosis, and Management,” which was early published by Pediatrics in November (10.1542/peds.2022-060179).
The authors provide an update on what is currently known about mpox in children and adolescents, based on 22 reported pediatric cases.
Among their findings:
- Although it is usually transmitted through close skin-to-skin or mucosal contact with lesions, mpox can less commonly be transmitted through respiratory secretions or transplacentally. For those who are sexually active, condom use may not prevent infection, as condoms may not prevent all skin-to-skin contact with lesions.
- The rash can be papular, vesicular, pustular, and/or umbilicated. It can be on the trunk or extremities. Importantly – and different from varicella – the lesions are typically at the same stage, and the rash progresses slowly (2-4 weeks). The lesions are often quite painful.
- Fever, chills, and/or sweats are commonly reported. Lymphadenopathy (particularly cervical), sore throat, and headache are also common symptoms.
- Diagnosis is generally made by polymerase chain reaction (more commonly known as PCR) testing of samples obtained by “vigorous swabbing” of the rash.
- The lesions should be covered and kept clean to prevent secondary infection and additional inoculation. In particular, it is important to keep children from picking at the lesions and then touching their eyes, as ocular infection can result in permanent corneal scarring.
- Patients are considered contagious until the lesions have healed, the scars have fallen off, and a new layer of skin has formed.
There is much more in this State of the Art Review – about the epidemiology, vaccines, and medications. If you’re like me and have felt the need to learn more about this disease, you will find this article helpful.
