Pediatric Article
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Monkeypox and the Impact of Pediatric Infections

By Santa J. Bartholomew M.D. FAAP, FCCM

Monkeypox and The Impact Of Pediatric Infections

Monkeypox is a rare viral disease that is similar to human smallpox. Prior to 2021, the last outbreak of monkeypox in the United States occurred in 2003, when there were 47 confirmed and probable cases. However, the majority of these cases were imported from Africa, where the disease is more common. 

The first known outbreak of monkeypox occurred in 1958 in the Democratic Republic of Congo. This outbreak was confined to monkeys, while the first documented human case of Monkeypox was not discovered until 1970. 

Since then, there have been sporadic outbreaks of the disease in Africa. The largest outbreak of monkeypox occurred in 1996-1997 in the Congo Basin region. During that outbreak, more than 500 people were infected and 37 people died. 

Studies have shown that children under the age of five are three times more likely to die from monkeypox than adults.

What is Monkeypox?

Monkeypox is caused by a virus from the Orthopoxvirus genus. This family of viruses includes variola virus, which causes smallpox, and vaccinia virus, which is used in the smallpox vaccine. There are two different strains of monkeypox virus: West African monkeypox and Central African monkeypox. Central African monkeypox is more severe and has a higher fatality rate.

How Does Monkeypox Spread?

Monkeypox can be spread through contact with an infected animal, such as a monkey, rat, or squirrel. It can also be spread through contact with infected material from these animals, such as their blood or skin. The disease can also spread from person to person through close contact with an infected individual, such as touching or kissing them. 

How Does Monkeypox Impact Children?

Children are particularly susceptible to monkeypox infections. In fact, studies have shown that children under the age of five are three times more likely to die from monkeypox than adults. Monkeypox can be deadly in some cases, but with prompt medical treatment, patients have a good chance of recovery.

Recent Pediatric Monkeypox Infections and the Impact on Children

There have been several outbreaks of monkeypox in Africa over the past few years. Children have been adversely affected by these outbreaks. During a 9-month period in 2020, for example, 42% of those affected by the virus were children. 

What is concerning is that the case fatality ratio during this period for children under 5 years of age was 4.2%, which was a 0.8% increase from those over the age of five. 

In the United States, there have been 22,630 reported cases as of the publication of this article. California (4,300) and New York (3,679) exhibited the highest number of cases, with Florida (2,282), Texas (2,017), and Georgia (1,607) rounding out the top five states.

Children under 15 years of age were largely not impacted by the recent infections. The largest demographic impacted by Monkeypox in the US has statistically been men aged 31-35 years of age.


Although it is rare, monkeypox can be a serious illness, especially in young children. The best way to protect yourself from this disease is to avoid contact with animals that may be carrying the virus. Wash your hands thoroughly if you come into contact with an infected animal. If you think you may have been exposed to monkeypox, please seek medical attention immediately.