Mpox in Young Children, Late 2022: Most Caught It at Home

During the 2022 mpox (monkeypox) outbreak, children were rarely infected, but some were. From May 17 to December 31, 2022, the United States recorded 125 probable or confirmed cases in people under 18, 45 (36%) of them children aged 12 or younger.

An earlier CDC report covered cases up to September 24, 2022. Of 83 cases then, 28 (34%) were in children 12 and under; among the 20 of those 28 with information on exposure, most had caught mpox from someone in their household. This follow-up, by a CDC team led by Kaylea Nemechek and Ruth Stefanos with state and local health departments, covers September 25 to December 31, 2022.

The children

National surveillance identified 17 children aged 12 and under with probable or confirmed mpox. Health departments used a CDC questionnaire to ask about any contact with a person with mpox in the previous 3 weeks, where it happened, what kind of contact it was, and what precautions the infected person took.

• Three newborns, 7 days old or younger, were probably infected around the time of birth. All three were Black. These were the first U.S. newborn cases of the 2022 outbreak.
• Of the other 14: ten were aged 0–4 and four aged 5–12; nine were boys and five girls; nine were Black, two Hispanic and three non-Hispanic White.

How they were exposed

Among the 14 children other than the newborns:

Of the eight household exposures, four were direct caregivers and four were household members who were also caregivers.

For children with a known source, the kinds of contact reported most often were:

None reported contact through blood or body fluids, medical care, pets or shared toys.

Precautions — taken, but not always enough

Not everyone with mpox took precautions, and children may have been exposed before precautions began. As a recent case report of a toddler showed, even the precautions taken may not have been enough to stop spread from caregiver to child.

Protecting children

Early diagnosis and infection control are critical. Household members and caregivers with mpox — including pregnant women, and their health care providers — should be told about the risk to children and infants, and protective steps should start immediately:

• isolate household members who have mpox;
• keep adults and children with mpox apart from other household members;
• have people with mpox older than 2 wear a mask when possible;
• limit how many people care for a child with mpox;
• when caring for a child with mpox, avoid touching the rash and wear gloves;
• consider post-exposure prophylaxis for everyone in the household.

Limitations

• When precautions started relative to exposure was not recorded, and how many exposed children did not get mpox is unknown, so no precaution's effectiveness could be judged.
• Infections in children were rare, so the sample is small.
• There were too few cases to examine racial disparities in children and adults.
• Exposure histories may be distorted by faulty recall or by the wish to give socially acceptable answers.

Sources

Based on Nemechek K, Stefanos R, et al., "Notes from the Field: Exposures to Mpox Among Cases in Children Aged ≤12 Years — United States, September 25–December 31, 2022," MMWR, Centers for Disease Control and Prevention; a work of the United States government in the public domain.