Cases of monkeypox in children outside Africa are currently low (in Spain at least one 10-month-old baby is infected) and most are mild, but this is a population that presents a greater risk for pregnant women and those with the immunosuppressed. Is. , How should infections in little ones be managed?
The Ministry of Health has just published a guide ‘Management of monkeypox in children’ In which many associations and societies have participated in the Coordination Center for Health Alerts and Emergencies (CCAES) and Pediatrics (AEP and OEP); dermatology (AEDV); of infectious diseases; of gynecology and obstetrics (SEGO); primary care (SEMFYC, SEMG and SemerGen); of preventive medicine (SEMPSPGS); Emergency (Sems) and Ophthalmology (SEO).
As pointed out by experts who have also produced other guides dedicated to outpatients and hospitalized patients in the current outbreak in Europe, France, the Netherlands have described a few cases—the only ones outside of family contact. Happened – United Kingdom, United Kingdom and Spain.
Clinical signs in all of them (except one in the newborn) have been mild and rash has been the most significant symptom, but in this population group, they add, Increased risk of hospitalization and ICU admission.
Thus, children have a higher number of injuries (>100), providing greater severity, and most of all. risk of superinfection Bacteria that “could complicate matters”.
Monkeypox or Chickenpox?
The guide states that in younger children, epidemiological contact should aid diagnosis—usually they are intra-family contact—but in older children We must “assess the possibility of sexual contact (and even sexual abuse)”, For this reason, they should be asked if they are sexually active and, if they present suspected symptoms of another sexually transmitted infection (STI), the presence or co-infection of the STI should be considered.
In the pediatric age, ‘Monkeypox’ should be isolated Chickenpox, herpes zoster, enterovirus infection and ‘Molluscum contagiosum’ – is caused by a ‘poxvirus’ and consists of small dome-shaped warts that affect 40 to 50% of children at some point in their lives.
According to the document, although not in all cases, Monkeypox lesions occur at the same stage of maturationWhereas chickenpox occurs in different stages.
Furthermore, chickenpox is centripetal, starts on the trunk and spreads peripherally, whereas the lesions of monkeypox begin on the extremities (affecting the face and limbs, palms and soles) and spread in the centerHowever in this outbreak more localized abnormal lesions in the genital area have been observed.
Meanwhile, the rash associated with enteroviruses, especially hand, mouth, and foot disease, is Peripheral is also located.
Can a child be vaccinated?
For now, monkeypox vaccination plan considers prophylaxis pre-exposure in people with high-risk practices and post exposure There have been some incidents of close contacts, especially with children at high risk of serious illness, pregnant women and the immunosuppressed, as well as health and laboratory personnel, whose use of PPE has resulted in some.
The ‘Imvanex’ vaccine, which is currently being administered, “It is not contraindicated in children or in immunosuppressed patients.”
by existing a very limited number of doses (As of this Monday only 5,000 have arrived in Spain, another 7,000 are expected), they will be reserved for post-exposure prophylaxis of a confirmed case in the first 4 days of contact in high-risk patients.
if sufficient “Might be considered to give to all close contacts”But given the ever-changing situation, “the indications proposed by the Ministry of Health will be followed at all costs.”
Newborns of infected mothers: stop breastfeeding
Newborns whose mothers have active or incubating infections at delivery should be studied at birth and followed for the first 21 days of life. Evaluate the potential risk of perinatal transmission. If this happens, a long-term follow-up will be done to cancel the development of the sequel.
While the mother is in the transition period, the child, who would be considered close contact—and as such should not be quarantined—, You have to separate from him.
in present It is unknown whether the virus can be transmitted through breastfeeding.Therefore, “and until new recommendations, it seems reasonable” to do the opposite if the mother is infected or is in the incubation period.
The female will be able to express and discard milk until it is considered non-contagious or her isolation ends, at which time You can resume it directly from the chest.
However, in the event of a negative pCR in breast milk it will be “assessed” to be administered. If the newborn is infected Breastfeeding can be resumed directly from the breast.
If the infection appears in any trimester of pregnancy and the period of infection has passed at the time of delivery, the newborn can remain with the mother and Isolation is not required as it is not considered close contactUnless he develops symptoms, in which case he will become the case under investigation and will require study and isolation with his mother.
Otherwise, the recommendations for this population are the same as for the rest and include ‘Protocol for early detection and management of cases in the face of monkeypox alert (‘monkeypox’) That alert’s presentation was updated last Friday.
In such a situation, experts recommend isolating at home. until all symptoms are gone, all skin lesions have disappeared and the scab has completely fallen off and leave it for healing. At home, you should isolate yourself from cohabitants, stay alone in one room, and limit visits.
Also avoid physical contact and, in age with sexual activity, have intercourse until the sores disappear; Condom use is recommended for the first 12 weeks after the end of isolation, as well as Wear a well-fitting surgical mask whenever another person is present.
Do not share household items or objects, wash your hands frequently, avoid contact with animals and sweep, vacuum or dry dust-wet cleaning methods should be used (with bleach preparations) – and Open doors and windows while disinfecting.