The World Health Organization (WHO) has confirmed that the first infections of monkeypox have already been registered in children under 18 years of age. These are very isolated cases, but the international organization has recalled that children, as well as pregnant and immunosuppressed women, they are a risk group that is “great concern”, for which he has urged “use all public health measures” to prevent the virus from spreading in this age group. Although, in general terms, the epidemiological situation hardly changes: the outbreak still does not constitute a public health emergency of international concern, despite the fact that infections have skyrocketed in the last two weeks, as the WHO itself has warned.
Europe concentrates almost 90% of the laboratory-confirmed cases reported globally since mid-May. The infections have occurred, mostly, in young men who have sex with men. More than 5,000 cases have been detected in 51 countries, and Spain is among the most affected. As of this Friday, the National Epidemiological Surveillance Network has confirmed approximately 1,200 infections in our country.
The fact that most of the cases have been associated with a very specific profile has been able to indirectly harm the containment of the transmission of the virus, despite the fact that the health authorities have made an effort from the first moment to make it clear It is not a sexual disease. “I think one of the great mistakes that has been made is to have characterized the monkeypox outbreaks as if they were only outbreaks among men who have sex with men, when transmission can also occur in women and children without any sexual intercourse, because the only thing that is necessary is close contact and that the fluid that flows from the vesicles comes into contact with mucous membranes or with wounds”, he clarifies in this regard Daniel Lopez Acuna, epidemiologist and former director of WHO Health Action.
Many differences with Africa
Monkeypox is rare, although the number of infections has increased in recent years in Africa, where the disease is considered endemic. On the African continent, cases in children are generally more serious than those in adults, although the specialists remember that these are very different scenarios, so any comparison with countries like Spain would be far from reality. “We have several differences. One is that fortunately the strain of the virus that has affected the Western world has been the mildest. Another is that the states of immune competence in children are not comparable, since the prevalence of malnutrition in Africa generates greater susceptibility… And, of course, the quality of the health system as a whole,” explains López Acuña to RTVE.es.
Phylogenetic analyzes of the virus have described two different lineages: the one from Central Africa, more serious and with more complications; and West Africa, which is less pathogenic. The outbreak detected in non-African countries such as Spain would correspond to this second lineage.
Despite these differences, yes, it is expected that minors infected with monkeypox may develop more severe symptoms than adults, as their immune system has not yet fully matured and is therefore less competent. Something similar to what happens with traditional smallpox. However, “so far there is no indication that things are evolving in a worrying way, but we must be very cautious and monitor very closely,” reassures López Acuña.
This virus does not spread easily and the risk to the population is low. It can be transmitted by the respiratory route, but the main means is contact with fluids, since contagion takes place through contact with wounds, body fluids, droplets and contaminated material, such as bedding. Asymptomatic transmission, although possible, is unlikely; while the incubation period is usually 6 to 16 days, but can extend up to 21 days.
“We are not facing a phenomenon such as COVID-19, which has massive community transmission. That is why the key is that there are no close contacts of children with people who have monkeypox lesions, which implies effective isolation. of those who are affected and in case there are children in the immediate area, protect them as much as possible”, points out Daniel Lopez Acuna, who remembers that close contacts must be monitored, in addition to vaccinating them in the first days. This epidemiologist considers that, beyond these precautions that are valid for both adults and minors, parents do not have to adopt any other additional measures.
Two to four weeks of illness
Monkeypox causes symptoms very similar to those of smallpox, even milder, although it can also cause the death of the patient. The disease begins with a headache, fever, chills, muscle aches, extreme fatigue and, unlike smallpox, swollen lymph nodes. One to three days after the onset of fever, a rash develops.which usually manifests itself first on the face and then spreads to other parts of the body, including the palms of the hands and the soles of the feet.
As in smallpox, the rash begins as red spots, which eventually turn into pustules. After several days, these pustules form a scab, which ends up falling off. The full picture usually lasts two to four weeks.