First cases of monkeypox in children in the US confirmed

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The first two US cases of monkeypox in children have been confirmed as part of a record outbreak of more than 2,800 infections nationwide, a top health official said Friday.

The pediatric cases, detected this week in an infant and a toddler, are likely the result of household transmission, according to the Centers for Disease Control and Prevention. CDC Director Rochelle Walensky disclosed the development in a Washington Post Live interview Friday.

CDC and public health authorities are still investigating how the children became infected. The two cases are unrelated and in different jurisdictions, the agency said in a statement. The toddler is in California; the infant’s case was confirmed while the family was traveling in Washington, DC, but they are not residents of this country.

Walensky, in her interview, said the cases link back to individuals who come from the men who have sex with men community. But the investigations are ongoing to “know or understand” the connection to that community, another CDC official said.

“While both children have monkeypox symptoms, they are in good health,” and receiving an antiviral treatment for the disease, the CDC said.

Since the outbreak began in May, the vast majority of monkeypox cases have occurred among men who are gay, bisexual, or who have sex with men. Officials emphasize that the pathogen can affect anyone who has close contact with people who have monkeypox, including children. However, they say they have not yet seen evidence of sustained transmission outside of networks of men who have sex with men.

“I don’t think it’s surprising that we are occasionally going to see cases in individuals who are not gay, bisexual or other men who have sex with men. … The social networks that we have as humans means we have contact with a lot of different people,” Jennifer McQuiston, who leads the CDC’s monkeypox response, told reporters Friday. “The primary drivers for this infection in the US remain in the gay, bisexual and other men who have sex with men communities right now. But we need to continue watching this and we stand ready to … respond.”

Monkeypox spreads through close skin-to-skin contact, which — in the case of children — could include holding, cuddling, feeding, as well as through shared items such as towels, bedding, cups, and utensils. Health officials say respiratory spread is also possible, but usually over prolonged periods of time, such as when a person lives in the same home as an infected person.

The rapid spread of monkeypox in the United States and other countries where it is not endemic, including the United Kingdom, Portugal and the Netherlands, has alarmed public health officials. The World Health Organization, which stopped short of declaring the monkeypox outbreak a global emergency last month, has been reconsidering that decision and is scheduled to announce Saturday whether it would reverse course.

Efforts to track cases in the United States have been undercut by limited demographic data. Last week, CDC officials acknowledged they had details such as gender and age for only about 700 patients — fewer than half of the confirmed cases at the time. Among cases with detailed information, 99 percent involved male-to-male sexual activity, officials said Friday. A handful of women and transgender men also tested positive.

The median patient age is around 36 with the oldest patient in their 70s, McQuiston said Friday.

Walensky has said the agency expects cases to continue to climb through August as a result of a testing scale-up and greater awareness and outreach to clinicians.

In most cases, monkeypox symptoms disappear on their own within a few weeks. But for children, those who are pregnant and people with weak immune systems, the disease can lead to medical complications, including death, according to WHO.

US monkeypox missteps mirrors early coronavirus response, experts say

During the current outbreak, a few countries have confirmed a handful of monkeypox cases in those under 18. The CDC’s European counterpart tallied at least five cases on Wednesday. Authorities in Spain announced Wednesday they had detected a case in a 7-month-old.

In the United Kingdom, only one child has tested positive for monkeypox out of nearly 2,200 confirmed cases as of Wednesday. Health authorities said there is “no robust evidence of sustained transmission” outside of same-sex male sexual networks, while cautioning the 13 female cases require close surveillance.

In the United States, health officials have made a limited supply of monkeypox vaccines available to prevent infections, or reduce the severity of disease after exposure. They are reserving shots for the highest-risk individuals, usually sexually active gay and bisexual men, or those with known exposures. The US Department of Health and Human Services says the nation will have 7 million doses by the middle of next year as additional shipments arrive.

The antiviral medication TPoxx is also available to treat people with severe cases, although patients and doctors complain it has been difficult to access because of an onerous process required by the federal government. The CDC announced Friday it was eliminating some requirements to ease access.

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