► Should we be worried about the first case of monkeypox in children?
Saturday June 25, the regional health agency (ARS) of Île-de-France reported a case of monkeypox (“monkeypox”) in a primary school child. This is the first case affecting a child in France, where, moreover, 330 adults are infected, including 227 in the Ile-de-France region. Another “probable” case is being examined in the same siblings, and the parents of the children at the school have been notified to monitor the appearance of symptoms.
The health authorities remain reassuring and recall that “the cases in France and Europe are mild” and “the risk of transmission is assessed as low”. For its part, the World Health Organization (WHO) made public its conclusions after the emergency meeting convened on Thursday. « PoAt this time, the event does not constitute a public health emergency of international concern, which is WHO’s highest level of alert.” and the one that had been triggered for the Covid-19, said the director general of the agency. Although it also states « d’igrowing concerns about international distribution”.
► How could a child be infected?
While the majority of cases reported so far have been in adult males and are thought to be related to sex, monkeypox is transmitted through contact with the lesions. If these are located in the genital mucous membranes, transmission takes place during sexual intercourse. But the lesions also appear on the hands and feet, sometimes the face and in the mouth. It is therefore possible to become contaminated by touching another person’s pimples and lesions, or even by contaminated linen or cutlery.
The chain of contamination that led to the case of the child has not yet been traced, but could have taken place in the family or through close contact with infected adults or children. The problem in children is to make the diagnosis in relation to chickenpox.
► Is it more serious for children and is there a treatment?
Cases of monkeypox are more severe in children in West Africa, where the disease is endemic, but are not expected to be in Europe. Because more than the disease itself, it is superinfections when patients scratch their pimples that are responsible for mortality. Since children are more prone to scratching, they experience more complications. In countries where access to care is limited, these secondary infections are poorly managed, which is not the case in France.
For the moment, no preventive treatment or vaccination is systematically recommended by the health authorities for children, and any decision will have to be taken on a case-by-case basis in agreement with the doctors. An antiviral drug exists, tecovirimat, but it only has exceptional authorization in Europe. It should not be used in children and pregnant women, and it has important interactions with other drugs. Its use is therefore highly restricted, especially given the benefit-risk balance in relation to a relatively mild disease.