Monkeypox in a Young Infant – Florida, 2022 (2024)

Weekly / September 23, 2022 / 71(38);1220–1221

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On September 19, 2022, this report was posted online as an MMWR Early Release.

Katharine E. Saunders, DNP1; Andrea N. Van Horn2; Helen K. Medlin2; Ann Carpenter, DVM1,3; Philip A. Lee, MSc2; Liliana Gutierrez, MD4; Joshua Dillon, MD5; Alexandra P. Newman, DVM6; Anne Kimball, MD3; David W. McCormick, MD3; Danielle R. Stanek, DVM2 (View author affiliations)

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In August 2022, the Florida Department of Health (FDOH) was notified of a suspected case of monkeypox in an infant aged <2 months who was admitted to a Florida hospital with a rash and cellulitis. This case report highlights findings from the related epidemiologic investigation and describes the public health actions taken. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.* This is the youngest patient with confirmed monkeypox infection in Florida to date.

The infant was initially evaluated in an emergency department (ED) for a raised erythematous rash on the arms, legs, and trunk which had been present for 5 days. A rash swab was collected for bacterial culture and yielded a negative test result. Varicella, herpes simplex virus, and HIV testing were also negative. The patient returned to the ED 2 days later, at which time the rash had progressed to include numerous, diffusely scattered papulovesicular lesions over the body, many with central umbilication. The infant was admitted to the hospital with a diagnosis of molluscum contagiosum and started on intravenous antibiotics for secondary bacterial cellulitis associated with having scratched a lesion on the arm. The lesions subsequently spread to the back, soles of feet, face, and eyelid and became pustular over the first few days of admission. Swabs from forehead and back lesions tested positive for Orthopoxvirus DNA and Clade II Monkeypox virus DNA by polymerase chain reaction 10 days after rash onset (Figure). Results were confirmed by the Florida public health laboratory and CDC. FDOH and hospital clinicians consulted with CDC regarding treatment options. The infant was treated with oral tecovirimat and Vaccinia Immune Globulin Intravenous (1). Prophylactic trifluridine§ drops were administered to prevent ophthalmic complications from the eyelid lesion. The infant remained afebrile and stable throughout the course of illness, tolerated the treatments well, and fully recovered.

The infant had no history of travel, no history of acute infections in the 3 weeks preceding rash onset, no known immunocompromising conditions, did not attend a child care facility, and had no caregivers outside the home. Within the home, the infant was cared for by four caregivers. Caregiver A acted as the main guardian throughout the infant’s hospital stay and had prolonged exposure with skin-to-skin contact. Caregiver B reported activities that placed him at high risk for monkeypox exposure during the 2 months preceding the infant’s illness (2). Caregiver B reported hematuria and fever, followed by a rash within the 3 weeks before the infant’s symptom onset. One day before the infant became symptomatic, caregiver B moved to another state and sought medical care for his symptoms. He received a positive Orthopoxvirus DNA test result 2 days after the infant’s positive test result, after which, he was lost to follow-up. The infant had daily close contact with caregiver B in the home for 6 weeks before rash onset. Possible routes of transmission included shared bed linens and skin-to-skin contact through holding and daily care activities. Investigation identified three other household family members with household exposures to both the infant and caregiver B. Caregiver B, caregiver C, and the infant shared a bed for the 6 weeks preceding the infant’s symptom onset. All household members (caregivers A, B, C, and D) held the infant with close skin-to-skin contact. Caregivers A, C, and D received postexposure prophylaxis with JYNNEOS vaccine and remained asymptomatic at 22 days after the infant’s symptom onset (2,3). Caregiver A had also received smallpox vaccination during childhood.

To date, 27 confirmed cases of monkeypox in pediatric patients aged 0–15 years have been reported in the United States during the 2022 outbreak (4). Clinical presentations in children with monkeypox have been similar to those in adults, although children might have a higher risk for severe disease (5). Timely laboratory identification and thorough epidemiologic investigation are critical for effective public health response to monkeypox infection. In this case, contact tracing and postexposure prophylaxis vaccination of close contacts of the affected infant might have prevented further transmission to household members (3). Clinicians should consider monkeypox infection as a differential diagnosis in pediatric patients with pustular or vesicular rashes and be aware of the possibility for household transmission to pediatric patients, particularly if the children meet epidemiologic exposure criteria for diagnosis of monkeypox (6).

Corresponding author: Katharine E. Saunders, ksaunders2@cdc.gov.

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1Epidemic Intelligence Service, CDC; 2Florida Department of Health; 3CDC Monkeypox Emergency Response Team; 4Orlando Health, Arnold Palmer Hospital for Children, Orlando, Florida; 5AdventHealth for Children, Orlando, Florida; 6New York State Department of Health.

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All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

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* 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

Patient specimen tested positive for nonvariola Orthopoxvirus DNA by polymerase chain reaction at Florida Bureau of Public Health Laboratories and was confirmed positive for Clade II Monkeypox virus DNA at CDC.

§ Prophylactic trifluridine is an antiviral drug for topical treatment of epithelial keratosis caused by herpes simplex virus.

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References

  1. CDC. Monkeypox. Clinical considerations for monkeypox in children and adolescents. Atlanta, GA: US Department of Health and Human Services, CDC; 2022. Accessed September 3, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pediatric.html
  2. CDC. Monkeypox. Monitoring and risk assessment for persons exposed in the community. Atlanta, GA: US Department of Health and Human Services, CDC; 2022. Accessed September 9, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/monitoring.html
  3. CDC. Monkeypox. Vaccines. Atlanta, GA: US Department of Health and Human Services, CDC; 2022. Accessed September 5, 2022. https://www.cdc.gov/poxvirus/monkeypox/vaccines/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fpoxvirus%2Fmonkeypox%2Fvaccines.html
  4. CDC. Monkeypox. Monkeypox cases by age and gender, race/ethnicity, and symptoms. Atlanta, GA: US Department of Health and Human Services, CDC; 2022. Accessed September 12, 2022. https://www.cdc.gov/poxvirus/monkeypox/response/2022/demographics.html
  5. Huhn GD, Bauer AM, Yorita K, et al. Clinical characteristics of human monkeypox, and risk factors for severe disease. Clin Infect Dis 2005;41:1742–51 . https://doi.org/10.1086/498115 PMID:16288398
  6. CDC. Monkeypox. Case definitions for use in the 2022 monkeypox response. Atlanta, GA: US Department of Health and Human Services, CDC; 2022. Accessed September 9, 2022. https://www.cdc.gov/poxvirus/monkeypox/clinicians/case-definition.html

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FIGURE. Timeline of symptom onset, testing, treatment, and public health interventions in response to a case of monkeypox in an infant* — Florida, 2022

Monkeypox in a Young Infant – Florida, 2022 (2)

Abbreviations: ED = emergency department; FDOH = Florida Department of Health; PCR = polymerase chain reaction; PEP = postexposure prophylaxis; Tpoxx = tecovirimat; VIGIV = Vaccinia Immune Globulin Intravenous.

* Caregiver B and caregiver C shared a bed with infant.

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Suggested citation for this article: Saunders KE, Van Horn AN, Medlin HK, et al. Monkeypox in a Young Infant — Florida, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1220–1221. DOI: http://dx.doi.org/10.15585/mmwr.mm7138e3.

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Monkeypox in a Young Infant – Florida, 2022 (2024)

FAQs

Is monkeypox in a young infant in Florida 2022? ›

In August 2022, the Florida Department of Health (FDOH) was notified of a suspected case of monkeypox in an infant aged <2 months who was admitted to a Florida hospital with a rash and cellulitis.

Can babies get monkey pox? ›

While children aren't at high risk for contracting monkeypox, they are still susceptible to the virus, and in fact young children are at increased risk for more severe outcomes if they become infected.

How to treat monkeypox in children? ›

Tecovirimat is the first-line medication to treat mpox, including in children and adolescents. Children and adolescents with close contact to people with suspected, probable, or confirmed mpox may be eligible for post-exposure prophylaxis (PEP) with vaccination, immune globulin, or antiviral medication.

How does monkeypox look at first stage? ›

Stage 1: Macules - flat, distinct, discolored areas of skin Stage 2: Papules - raised spots on the skin that are less than one centimeter wide Stage 3: Vesicles - small fluid-filled blisters on the skin Stage 4: Pustules - small, inflamed, pus-filled, sores (lesions) on the skin surface Stage 5: Scabs - hardened crusts ...

Is monkeypox still in Florida? ›

Mpox is still circulating in the U.S. including Florida. Many countries outside the U.S. do not have vaccines widely available to help reduce mpox activity in those at increased risk for mpox.

What ages are most affected by monkeypox? ›

The demographic that has been hit the worst is ages 24-35. 98% of infections have occurred in LGBTQ men. However, all ages, genders, sexual orientations, and races have been affected by Monkeypox.

How do I know if my child has monkeypox? ›

What Are the Signs & Symptoms of Mpox? Mpox causes fever, headache, body aches, swollen lymph nodes , and a rash. The rash begins as flat spots that turn into bumps, which then fill with fluid. Some people develop spots that look like pimples or blisters before having any other symptoms.

Who is at risk for monkeypox? ›

While some people have less severe symptoms, others may develop more serious illness and need care in a health facility. Those typically at higher risk of more severe symptoms include people who are pregnant, children and persons that are immunocompromised, including people with untreated and advanced HIV disease.

What does monkeypox rash look like? ›

People may have only 1 or 2 bumps on their skin. These bumps can look like a blister, pus-filled bump, or open sore. Even with a few bumps, the rash can be painful. Some people seek medical treatment for the painful rash.

Is monkey pox itchy? ›

For some people, the first symptom of mpox is a rash, while others may have different symptoms first. The rash begins as a flat sore which develops into a blister filled with liquid and may be itchy or painful. As the rash heals, the lesions dry up, crust over and fall off.

Does monkeypox go away? ›

Most people recover without treatment after a few weeks. In rare cases, people can become very sick and die. People usually develop symptoms 7 to 10 days after being exposed to the monkeypox virus.

How to prevent monkey pox? ›

Isolate people who have mpox from healthy people. Wash your hands well with soap and water after any contact with an infected person or animal. If soap and water aren't available, use an alcohol-based hand sanitizer. Avoid animals that may carry the virus.

What can be mistaken for monkeypox? ›

There are a variety of mimics of mpox, including smallpox, varicella, primary and secondary syphilis, acute retroviral syndrome, and genital herpes simplex virus.

Can you pop a monkeypox blister? ›

Don't lance (pop) or scratch lesions from the rash. This does not speed up recovery and can spread the virus to other parts of the body, increase the chance of spreading the virus to others, and possibly cause the open lesions to become infected by bacteria.

What are the 4 stages of monkeypox? ›

The evolution of lesions progresses through four stages—macular, papular, vesicular, to pustular—before scabbing over and desquamation. The incubation period is 3-17 days. During this time, a person does not have symptoms and may feel fine.

How did children get monkeypox? ›

While anyone can get monkeypox, even kids, it's most commonly found in men who have sex with men. If a child comes in close physical contact with a person who has monkeypox, they can get it too.

What is the mortality rate of monkeypox 2022? ›

As of November 6, 2022, the WHO reports a total of 78,229 (77,301 in nonendemic areas and 928 in endemic-African areas) laboratory-confirmed cases of monkeypox as well as 41 deaths (28 cases outside Africa) across 109 various countries (https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html).

What is the incubation period for monkeypox 2022? ›

The 95th percentile of the incubation period distribution, commonly used to determine the quarantine period, was 16–20 days across all studies of the global 2022 outbreak and was 17 days for the historical data.

What is the cause of monkeypox in 2022? ›

In 2022–2023 a global outbreak of mpox was caused by a strain known as clade IIb. Mpox can be prevented by avoiding physical contact with someone who has mpox. Vaccination can help prevent infection for people at risk.

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