- The CDC is issuing guidance for daycare and schools to help avoid monkeypox transmission.
- The agency advises washing hands regularly, disinfecting surfaces and shared objects, and asking children, staff and volunteers to stay home when sick.
- The risk of children and adolescents developing monkeypox is low, according to the CDC.
Schools, daycares ,and other settings serving children and adolescents do not need to take extra precautions against monkeypox, said the Centers for Disease Control and Prevention (CDC).
The agency advises these facilities to “follow their everyday operational guidance that reduces the transmission of infectious diseases.”
This includes washing hands regularly, disinfecting surfaces and shared objects, and asking children, staff, and volunteers to stay home when sick.
“At this time, the risk of monkeypox to children and adolescents in the United States is low,” the CDC said on its website, along with a series of Frequently Asked Questions.
As of August 24, more than 16,000 monkeypox infections have been reported to the CDC, with at least one case in all states and the District of Columbia.
But only a small number of cases have occurred in school-age children. CDC data published August 21 show that of reported cases, six were in children 0 to 5 years old, seven in children 6 to 10 years old, and four in children 11 to 15 years old.
This is based on nearly 70% of reported cases with age data available.
While “parents should be aware of monkeypox,” they should not be “overly concerned at this point,” said Dr. Amanda D. Castel, a professor in the department of epidemiology at The George Washington University in Washington, D.C.
Dr. Dean Blumberg, a professor in the division of pediatric infectious diseases at UC Davis Health in Sacramento, Calif., agreed with the CDC’s assessment of the low risk of monkeypox to children.
“[The monkeypox virus] is not easily transmitted, and there are signs that people are contagious, such as when they have the rash,” he said.
There has been some new evidence that monkeypox may be able to be spread by people who are asymptomatic, but it’s unclear if that is a common issue.
Rash is one of the most common symptoms of monkeypox. People may also have fever, chills, muscle aches, or a headache.
Children have similar symptoms as adults, However, other conditions can cause a rash in children, such as chickenpox, measles, allergic skin reactions, and drug-related reactions.
So, “if your child has a rash, don’t panic,” said Castel. “It could be something else.”
Most cases of monkeypox in children and adolescents get better on their own without treatment, according to the CDC.
Some children are at higher risk of severe disease, including children under 8 years of age, with an immune-compromising condition, or with certain skin conditions such as eczema, severe acne, or burns.
CDC data shows that during the current outbreak in the United States, the majority of monkeypox cases have been associated with sexual contact or close intimate contact.
However, the monkeypox virus can infect anyone — including children — who has close, personal, often skin-to-skin contact with someone with monkeypox, the CDC said.
In spite of that, Blumberg said children are unlikely to have this kind of contact in school settings.
“Although children might horse around with each other, there are very few children who are going to have prolonged skin-to-skin contact with other students or staff at school during normal school activities,” he said.
Some exceptions, he said, would be activities such as wrestling and similar sports.
“But I think coaches and other school staff are well-versed in excluding children who have rashes from participating in that sort of activity,” he said.
Monkeypox virus may also spread by touching contaminated objects, fabrics, and surfaces that have been used by someone with monkeypox, although the CDC guidance said this route of transmission has been less common during the current outbreak.
In addition, the CDC said that children, staff, and volunteers generally do not need to be excluded from a school, daycare or other setting if they have been exposed to monkeypox and do not have symptoms.
“I don’t think this can be stressed enough,” said Castel, “but we really have to talk about monkeypox in a non-stigmatizing way, and try to be fact-based in our discussions.”
The CDC’s guidance for schools and daycares echoes its recommendations for the general public, which said that people exposed to monkeypox virus can continue their daily activities as long as they do not have signs or symptoms of monkeypox.
In its guidance, the CDC said in some cases involving a high-risk exposure, the local health department may limit a person’s participation in certain activities.
In addition, boarding schools, overnight camps, and other residential settings should follow the agency’s guidance for congregate living settings.
Blumberg said schools and daycares already have “robust” experience and policies for dealing with staff or children who are sick or potentially contagious, including those with a rash or fever that may indicate a contagious infection.
In addition, parents should monitor their children for symptoms before sending them to school or daycare.
“If your child is sick, they should stay home,” said Castel. Also, “if they develop a rash — which often happens in children — one that is perhaps accompanied by a fever, parents should reach out to their pediatrician or health care provider.”
Blumberg said clinicians can also help determine the cause of a child’s rash.
“If any parent or school staff has concerns about a rash potentially being monkeypox, they should make sure to have it evaluated,” he said, “because now there is widespread testing availability.”
Overall, Castel thinks the CDC guidance is “pretty comprehensive.” However, she would also like to see the information presented in a way that describes the distinct risks for different age groups.
“What a parent does with a toddler in terms of prevention — helping them learn how to wash their hands regularly and that kind of thing — is different than [talking to] an adolescent or college student that might be involved in some close intimate relationship,” she said.
In addition, she urges parents to keep monkeypox in perspective as we head into the fall.
“The risk of monkeypox [for children and adolescents] is very low currently,” she said, “but we also need to make sure that kids are getting their routine childhood vaccinations — including polio, and hopefully soon the COVID boosters, if they’re eligible.”
“That will help children be prepared and healthy as we launch into this new school year,” she said.