The first two cases of monkeypox in US children from the current outbreak have been reported by the Centers for Disease Control and Prevention (CDC). One is a toddler in California, the other is an infant that is not a resident of the United States, whose family was travelling through Washington DC. The cases are likely due to household transmission. Both children are being treated and they are currently in good health.
These two were the first known cases in children in the US since 2003, when an outbreak from exotic pet imports led to a child being infected after coming into contact with an infected pet prairie dog. The whole outbreak had 47 confirmed and probable cases across six states.
The 2022 outbreak is significantly larger in magnitude – at the time of writing, the CDC reports 16,836 total cases of monkeypox across 74 countries, with five deaths in Africa. The disease is endemic in West and Central Africa, but has spread in many countries where it is not normally endemic.
A few weeks ago, the World Health Organization estimated that 60 percent of the cases whose sexuality was known were in men who have sex with men. Statistically, cisgender men were the most common group, but a few cases in cisgender women and transgender men have also been reported. There are also been infections among health workers, likely due to occupational exposure.
Miscommunication in reporting and prejudice have been responsible for the widespread belief that monkeypox is a sexually transmitted disease, which it is not. The disease spreads very efficiently via contact with an infected individual’s skin or bodily fluid, but there is evidence that an airborne route is possible. That combination makes sex an effective mode of transmission, as you tend to have to get pretty up close and personal for that – but doesn’t make monkeypox a sexually transmitted disease.
In Africa, the current strain had a mortality rate of 1 percent, but in non-endemic countries it seems to be significantly lower. The onset of symptoms is also different, which might lead to people not realizing they have the disease. The classical clinical presentation is of fever, swollen lymph nodes, and rash. However, the WHO reports that in the cases that presented at least one symptom, 81 percent had a systemic rash, and just half had a fever.
Effective treatments and vaccines exist for monkeypox – the same ones which successfully eradicated smallpox from the planet. The rollout to the most at-risk communities – men who have sex with men and health care workers – has been unfortunately slow and full of missteps, leaving many uncertain about the disease and what to do. This left most of the burden to inform, reassure, and vaccinate to sexual health clinics, already underfunded.
Despite that, thanks to community organizing, thousands of those most at risk have queued for several hours in cities across the world to receive vaccinations over the last several weeks.