What parents need to know about monkeypox

The coronavirus aside, a different viral disease has parents everywhere on high alert. Over the weekend, President Biden sounded the alarm about a spate of unusual cases of monkeypox, a rare virus similar to smallpox that, Biden stated, “if it were to spread it would be consequential.” 

Given the rapid rate of increase of monkeypox cases—officials are now tracking more than 100 cases outside of the Western and Central African countries where it typically occurs—it’s understandable to be worried that a new viral outbreak would tax our healthcare system even more than Covid already has. It’s also concerning that a virus is on the rise that could potentially have a worse impact on our more vulnerable populations, including children, pregnant women or those who are immunocompromised. 

Just the mere thought that there could be a second pandemic about to begin is a lot to bear. But experts assure that monkeypox is different from Covid in terms of transmission method, and we have better tools now, like masks and social distancing, to help alleviate the spread. We’re also better at detecting it.

“Transmission is really happening from close physical contact, skin-to-skin contact. So it’s quite different from Covid in that sense,” said Dr. Maria Van Kerkhove, the World Health Organization’s (WHO) technical lead on Covid-19, in a live online Q&A on Monday. 

While researchers are actively working to learn more about monkeypox and how it is transmitted in humans, unlike the coronavirus, monkeypox is not a novel disease—which means we already know more about it, and a vaccine already exists that can potentially help with inoculation for those at higher risk. Here’s what else you need to know.

What is monkeypox?

Initially identified in laboratory monkeys, which is where it got its name, monkeypox is a rare viral disease similar to smallpox (though less severe) that typically occurs in Western and Central Africa. 

The latest outbreak was first identified in the United Kingdom in early May, according to the WHO, and cases have been reported mostly in the U.K. and Europe, including Belgium, France, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, as well as in Canada and Australia. The first U.S. case was confirmed this week in Massachusetts and others are currently under investigation in New York City, Florida and Utah, according to the Centers for Disease Control and Prevention (CDC)

Monkeypox is a zoonotic disease, which means it primarily passes from animal to animal, and animal-to-human transmissions are considered rare, but can happen. 

However, human-to-human transmission can happen, too, and experts are concerned because there have been recent cases of monkeypox reported in people with no direct travel links to endemic areas where monkeypox usually occurs. This means that human-to-human transmission is happening among people in close physical contact with others who have symptomatic infection, says the WHO

Related: Here’s what you need to know about BA.2, Omicron’s new variant

What are the symptoms?

  • Rash, which starts with flat red marks that become raised and filled with pus, and can be itchy and painful
  • Fever
  • Chills
  • Body and muscle aches
  • Body weakness
  • Swollen lymph nodes
  • Fatigue

The monkeypox rash may start on the face, inside of the mouth, hands, feet or genitals and can spread all over the body. If your child has these symptoms or is in contact with someone who is infected, call your pediatrician immediately, says Tanya Altmann, MD, FAAP, a pediatrician and founder of Calabasas Pediatrics.

Symptoms can appear anywhere from five to 21 days after initial exposure, but typically start between six and 13 days. Symptoms may last between two and four weeks, and can be severe in children, pregnant women or those with suppressed immune systems, notes the WHO.

The virus is considered self-limiting, as once the lesions scab over in two to four weeks, they are no longer infectious. 

Related: Croup is now a symptom of Covid in kids

How is monkeypox transmitted?

Monkeypox is primarily transmitted via close contact to someone with symptoms of the disease, whether through lesions, bodily fluids, respiratory droplets from sneezing or coughing, or contaminated materials like utensils or bedding. It can also be transferred from mother to fetus via the placenta or as a result of close contact during or after birth.

But because monkeyvirus is larger and heavier than coronavirus, the respiratory droplets can’t travel as far (only a few feet), making it less likely you’ll get infected unless you’re in prolonged, very close contact with another person who is symptomatic. 

“One of the most challenging things about Covid has been that it can be spread asymptomatically or pre-symptomatically, by people who have no idea that they’re infected,” Dr. Rasmussen said, to the New York Times. “But with monkeypox it doesn’t appear that there is any pre-symptomatic transmission.” However, there are plenty of opportunities to transmit monkeypox in the first few days of an infection, when symptoms are non-specific, Dr. Rasmussen added.

Should I be worried about monkeypox?

Monkeypox could be a concern if case numbers keep increasing, but there’s no need to panic just yet, or revert to that early pandemic mindset when we were all scrubbing down groceries and afraid to leave our homes. That’s for several reasons: 

Covid is still the greater threat.

“The first thing to keep in mind is that monkeypox is not the same as Covid,” says Dr. Altmann. “The chance of having a widespread pandemic is very low based on the infection and how it’s transmitted.”

With Covid, people without symptoms can transmit the virus unknowingly, she adds. “With monkeypox, there is the classic monkeypox rash that would immediately raise red flags to a parent.” Because Covid case numbers are rising and are much more widespread, the coronavirus is the larger concern at this point.      

We have better tools at our disposal.

And we’re used to using them. Masks, social distancing and frequent handwashing can help prevent monkeypox from spreading. “Monkeypox is transmitted through very close contact, for example, you need to be in direct contact with someone for an extended period of time or in contact with bodily fluids, the rash itself or fluid-contaminated clothing or bedding,” notes Dr. Altmann.

Because monkeypox is similar to smallpox, health officials say that the vaccines and antivirals used for that disease can also be applied to monkeypox, giving us an arsenal to help control a larger outbreak.

Case numbers are very low.

The main concern with monkeypox is that cases are rising in countries where the virus does not typically circulate, but right now it’s happening mostly in closely knit communities, and in those who have recently traveled abroad. In the U.S., there are fewer than 10 cases.

“Based on currently available information, cases have mainly but not exclusively been identified amongst men who have sex with men (MSM) seeking care in primary care and sexual health clinics,” says the WHO in a statement. However, anyone can contract the virus, and it’s not necessarily spread through bodily fluids exchanged during sex, but is more likely due to contact with exposed lesions.

Monkeypox is rarely fatal.

In an interview with NPR, Raj Panjabi, MD, Senior Director for Global Health Security and Biodefense at the National Security Council, says cases seen in the U.S. so far have not been severe and aren’t likely to get much worse.

“Historically in countries with weaker health care systems less than 1% of patients have died from this milder strain,” Dr. Panjabi said. “We have access to vaccines and even treatments here in the U.S., and so the risk we believe is substantially lower.”

Preventing monkeypox

While there is no as-of-yet proven treatment for monkeypox, antivirals developed for smallpox may be helpful, notes the CDC. As for inoculation, smallpox vaccines have been studied in lab and animal models in Western and Central African countries against monkeypox and found to be effective

Although smallpox was eradicated in 1980 as a result of widespread vaccination efforts, the WHO has stockpiles of smallpox vaccines should a new outbreak occur.

What to do now

If you’re planning to travel this summer, there’s currently no need to alter your summer plans, says Dr. Altmann, but keep an eye on travel advisories at your destination.

If you have recently traveled to a state or country where monkeypox cases have been reported, monitor yourself and your family for any symptoms, especially a monkeypox rash, and report any concerns to your pediatrician or primary care provider.

And finally, it’s a safe bet to continue to practice social distancing measures and wearing a mask in public places and on public transportation to protect yourself and others from monkeypox—and Covid. 

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