Pediatrician and infectious disease specialist explains risks and prevention of Monkeypox with children

Pediatrician and infectious disease specialist explains risks and prevention of Monkeypox with children

The pediatrician and infectious disease specialist at the National Institute of Women’s, Children’s and Adolescents’ Health Fernandes Figueira (IFF/Fiocruz), Marcio Nehab, through Fiocruz’s channels, released information about the risks of Monkeypox (MPX) among children. Although adult men are the main group affected by the disease, children and people with low defenses or chronic diseases, according to the foundation, are at greater risk of contagion, something that was even reported by the director-general of the World Health Organization. (WHO), Tedros Ghebreyesus, in late July.

“This warning about vulnerable groups, together with the announcement of the first cases of the disease registered in children (which already reaches more than 80 in several countries around the world according to the United Nations Information Service in Geneva), makes the growing MPX’s outbreak raises concerns about its potential to spread into unexpected groups. This is what led the WHO to declare the outbreak a public health emergency of international interest”, points out Fiocruz.

According to Marcio Nehab, pediatrician and infectious disease specialist at the National Institute for Women’s, Children and Adolescents’ Health Fernandes Figueira (IFF/Fiocruz), there are signs and symptoms of monkeypox to be noticed among children. “Monkeypox should be considered when children or adolescents have a rash that could be consistent with the disease, especially if there are epidemiological criteria present. However, the Monkeypox eruption can be confused with other exanthematous diseases (those that present skin eruptions and that can be associated with infectious diseases common in children), such as: chickenpox; hand, foot and mouth disease; measles, molluscum contagiosum, chicken pox, scabies and allergic skin rashes”, he details.

The symptoms of the disease, both among adults and children, are the same, starting with fever, muscle, back and headache pain, moving on to chills, swollen lymph nodes, fatigue, followed by a rash. “Up to three days after having a fever, the patient may develop a rash on the face and body that progresses to crusty lesions on the skin. Lesions can affect the face, palms and soles, and the entire body, mucous membranes, and genitalia. They can also present with lesions at different stages of development with spots, blisters and crusts at the same time”, adds the doctor.

There are also rare complications from MPX that include abscesses as well as “airway obstruction due to severe lymphadenopathy, cellulitis, encephalitis, secondary skin infection, keratitis, pneumonia, sepsis, and eye diseases that can lead to loss of vision,” he adds. .

contagion among children

According to the pediatrician, among children, Monkeypox is transmitted mainly through skin-to-skin contact between humans, in a prolonged and direct way. “While most cases so far have been linked to sexual activity, Monkeypox is not considered a sexually transmitted infection. Thus, in children, the disease can be spread by close contact with body fluids from infected individuals, such as respiratory secretions, and by direct contact with skin lesions and crusts. The contagion can be from people or animals, and also through contaminated objects (by hosting an infectious agent that allows its transmission), for example, through clothes, sheets and towels”, completes Nehab.

“So people can transmit monkeypox to children through contact, such as kissing and hugging. With regard to contagion, it is also important to remember that, in the case of MPX, there is no transmission before symptoms appear”, emphasizes the doctor.

Disease incubation and severity

According to Marcio, in the current context, it is understood that the incubation period of Monkeypox, that is, the time that the person is infected by the disease until they show symptoms, is about 12 days, with a possible interval of 5 to 24 days. The rash appears two to four days later. “People with the disease can transmit it while they have symptoms, that is, between 2 and 4 weeks of duration. Newborns, young children, children with eczema or other skin conditions, and children with conditions that lead to immunosuppression may be at increased risk for serious illness.

Treatment

According to Nehab, in cases of suspicion or confirmation of MPX among children and adolescents, as well as in cases of risk of serious illness or complications due to the disease, a specific treatment is indicated on a case-by-case basis. “Tecovirimat is the first-line antiviral drug to treat the disease, including in children and adolescents. On the other hand, children and adolescents with exposure to people with suspected or confirmed monkeypox may be eligible for Post-Exposure Prophylaxis (PEP) with vaccination, immunoglobulin or antiviral medication.

“But right now in Brazil, we still don’t have vaccines or antivirals for the prophylaxis or treatment of infected or exposed people. In addition, caregivers and pediatricians should be alert to signs of secondary bacterial skin infection and prompt antimicrobial institution, on a case-by-case basis, if indicated”, emphasizes the doctor.

Prevention

With regard to disease prevention among children, Marcio Nehab emphasizes that it is essential for parents, families and caregivers to act, focusing on practices to avoid contact with contaminated people and their bodily fluids, something that even includes objects used by other people. . “The use of the well-fitting mask and even reducing the number of caregivers with the disease, when possible, for children are essential in preventing the spread of the virus. In order to avoid self-inoculation and more serious diseases, special attention must also be given by parents and guardians to prevent children with monkeypox from scratching their lesions or touching their eyes”, he adds.

“Children and adolescents who have had close contact with a person with monkeypox (e.g. domestic contact, with another family member, caregiver or friend) should be evaluated and given Post Exposure Prophylaxis (PEP) with JYNNEOS or ACAM2000 (for children with more than 12 months) or treatment, when indicated (in the case of countries and places where there are antivirals and vaccines necessary to combat this disease)”, informs the pediatrician.

Post-Exposure Prophylaxis

The doctor also explains in relation to the effectiveness of Post-Exposure Prophylaxis (PEP) for the treatment of Monkeypox. “Data are still limited on the effectiveness of PEP for children who have been exposed to monkeypox. No treatments, vaccines and other medications are currently licensed for children or adolescents. However, PEP should not be overlooked in children or adolescents who are eligible. Decisions on PEP provision should take into account the patient’s degree of exposure and individual risk of serious illness. In countries where these drugs are available, they are being used on a case-by-case basis,” says Nehab.

“The earlier a child or adult exposed to MPX receives the vaccine, if there is an indication, the greater the benefit. The indication is that the vaccine be administered within 4 days from the date of exposure in order to prevent the onset of illness. If administered between 4 and 14 days after the date of exposure, vaccination can reduce symptoms, but it may not prevent the disease”, concludes the doctor Marcio Nehab.

With information from IFF/Fiocruz

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