Can Kids Get Monkeypox? What We Know Right Now, for Parents and Caregivers

Monkeypox has existed for decades, but we're now seeing multiple outbreaks across the United States. According to the Centers for Disease Control and Prevention, over 4,600 cases have been detected nationwide.

Monkeypox is related to the smallpox virus, but it’s generally less severe and “much less contagious” than smallpox, according to the California Department of Public Health. While the symptoms — including a rash that causes lesions — can be very painful, the CDC says monkeypox is “rarely fatal,” and that “over 99% of people who get this form of the disease are likely to survive.” Being sick with monkeypox typically lasts 2-4 weeks.

As of July 25, there were only two known cases of monkeypox in kids in the United States. One of those children diagnosed with monkeypox is a California toddler. And despite these very small numbers, the risk of monkeypox to kids might naturally be on the minds of some parents and caregivers across the country.

KQED spoke to Dr. Yvonne Maldonado, professor of pediatrics and infectious diseases at Stanford University, about what you need to know about monkeypox in children at the moment. Her overarching message: “We shouldn't panic” about monkeypox and kids right now.

“I think it's really helpful for families to just know what the facts are at this point,” says Maldonado.

Anyone can get monkeypox, but right now, the risk to kids looks small

“There's no major risk for children” right now, says Maldonado.

Maldonado stresses there’s still just so much we don’t know, and can’t accurately predict yet. But because adults have been impacted by the monkeypox outbreak, “it’s not unreasonable to expect that there may be some spread into household contacts, especially children,” she says.

Monkeypox spreads from close physical contact with an infected person, including sustained face-to-face exposure via respiratory droplets. It also spreads through contact with items that have previously touched the rash or fluids of an infected person, which could include touching or sharing clothes, bedsheets or towels.

Monkeypox is not a sexually transmitted infection (STI). You cannot get monkeypox from casual conversations, or by passing someone with monkeypox (say, in a store) or briefly touching surfaces like doorknobs.

All of this means that “better containment” for people who may have been infected with monkeypox — isolating from other family members, for example — is one of the ways we can prevent the spread of monkeypox, along with better access to monkeypox vaccines.

Anyone can get monkeypox, but as we learn more about the current outbreak in the U.S., we’re seeing that infections are particularly affecting communities of gay and bisexual men, and men who have sex with men. The World Health Organization notes that trans people and gender-diverse people “may also be more vulnerable in the context of the current outbreak.”

“We are hoping that we can contain this, but there will still be some spread for an unknown period of time,” says Maldonado.

It's possible to mistake many common rashes in kids for monkeypox

Parents and caregivers know that rashes can be common in kids, and that figuring out what a particular rash could be — and if it’s a cause for real worry or necessitates a call to a pediatrician — can be hard. Adding concerns about monkeypox into that mix, especially at this time of year, could only make things tougher.

“This is summer virus season and there's just a lot of viruses out there that cause fevers and rashes in little kids,” says Maldonado. “This is the bread and butter of pediatrics, seeing kids with colds, rashes, fevers. That's very, very common.”

Maldonado says that when she first saw pictures of monkeypox rashes from this current outbreak, “some of the lesions — the less serious ones — really look like virus lesions that little kids can get. And I was worried that parents would just get panicked if they thought their kid had monkeypox, but probably it's just a local virus.”

“The main message right now is that it's rare in kids,” says Maldonado. “It still is much rarer than just being around a bunch of other kids and catching a summer virus.”

Despite what the name might suggest, monkeypox is not related to chickenpox at all — so your child’s chickenpox vaccination will not offer any protection against monkeypox. (If you personally got a smallpox vaccination as a kid before routine smallpox vaccines ended in 1972 in the U.S., that could be a different story. Read more about smallpox vaccines and monkeypox.)

Get more information with this visual guide to rashes in children and babies from the U.K. National Health Service, and also this pediatric rash explainer from Sutter Health.

We don't know a lot yet about how monkeypox affects kids

Monkeypox has existed for decades, with the first case among humans registered in 1970. (The disease is called monkeypox because it was first found in 1958 in monkeys.)

“There's two major strains that we know of, and it's really been hard to get a lot of information about childhood disease,” says Maldonado. “But we do know that children under 8, at least with the previous strains of monkeypox — not necessarily with the current strain that we're seeing circulate around the world, but those previous strains — seem to (be showing) more severe disease compared to adults.” Kids older than 8 years old, she says, “tend not to have as severe disease.”

Monkeypox is rarely fatal, and Maldonado says that in the context of this particular outbreak, the “major concern” for patients seems to be the rash the disease causes, and the painful nature of those lesions or pustules. And certainly, people who’ve had the disease recently have spoken about the often intense pain they’ve experienced during their infections.

“But fortunately, we haven't seen terribly severe disease, and I think that's really important to remember,” says Maldonado.

Kids could have options for monkeypox vaccines and treatment if needed

The monkeypox vaccine being offered in the United States right now is called Jynneos — a two-dose vaccine that’s also used to prevent smallpox.

Right now, Jynneos is only generally available for people age 18 and older, although “the CDC does have a special approval for giving the vaccine to children under 18,” says Maldonado. “But that needs to be given with some paperwork involved, because it's really not officially released by the FDA for general use.”

The CDC recommends that the vaccine be given to a person within four days of the date they were exposed to monkeypox, for the best chance of preventing onset of the disease. If a person gets the vaccine between four and 14 days of being exposed, the vaccine may reduce the symptoms of monkeypox, but may not prevent the disease altogether.

Supplies of the monkeypox vaccine in the Bay Area are distributed directly from the California Department of Public Health, who get their supply from the federal government. And right now, availability is still very limited and demand is high.

Currently, the antiviral drug Tecovirimat (also known as TPOXX or ST-246) is being used to treat those experiencing severe monkeypox. The FDA already has approved Tecovirimat to treat smallpox, and has recently expanded its use for monkeypox among adults and children.

But as with giving the Jynneos vaccine to kids, treating children – and adults, in fact — with TPOXX also gets complicated because of regulation. Maldonado says this treatment similarly has “some paperwork involved, because it's really not officially released by the FDA for general use” for monkeypox, because it’s licensed for smallpox.

“That doesn't mean it can't be used,” she says, but if a provider wants to use TPOXX to treat monkeypox, “there need to be forms that are filled out, going over the risks and benefits of the drug and the fact that they'd have to be informed consent.”

“So it is a little bit harder administratively to get a hold of, but there is that drug available — and it's available for all age groups,” says Maldonado.

You'll see monkeypox symptoms — and that's a good thing

Unlike COVID, monkeypox “isn't one of those diseases where you can be asymptomatic,” notes Maldonado.

She says it’s “very unlikely” we’ll see cases where a child is infectious but has no symptoms. “We have not seen that, for example, yet in the adults.”

This means that if a family is concerned their child might have monkeypox, “it would have to be most likely because they knew either that somebody very close to them or in the family was infected, or that somebody close to them or in the family was exposed, or that their child had symptoms that were similar to monkeypox,” says Maldonado. And unlike COVID, the visible symptoms of monkeypox mean it’s far more likely a person will realize they have it.

Schools might see a renewed focus on hygiene and sanitation

Maldonado emphasizes that it’s “really too early to tell what's going to happen in schools” when kids return after the summer break.

But she already suspects that heightened sanitary practices “are just going to be very helpful here” — and that the experience and familiarity that students and school officials already have with these practices because of COVID could be beneficial.

“This is really a disease that's transmitted by very close skin-to-skin contact, by very close and long-duration respiratory contact, as well as contact with contaminated clothing or other materials,” says Maldonado. “So those are things that I think we can control better in school settings than, for example, just coughing or breathing on each other [as with COVID]. That's a lot harder to control.”

Ultimately, “I suspect we'll just have to wait and see,” she says.

As with COVID, sick kids should be kept away from group settings

Schools might also think about keeping kids who have symptoms or a potential exposure to monkeypox away from the school setting temporarily, and away from other students, says Maldonado.

As for other settings in which kids will have physical contact, such as athletic leagues, Maldonado says the people running those organizations should keep doing what they’ve hopefully been doing through COVID, and continue to ask parents and caregivers not to bring their kids into these settings if they suspect they’re sick.

“We should always say that ‘no matter where you are and what you think you're sick with, you shouldn't really be in large gatherings if you have active respiratory or other illnesses,’” says Maldonado. “And so that would be the same.”