With the American monkeypox outbreak in a state of uncontrolled spread, public health authorities are concerned that outdated science and bad-faith scapegoating are combining forces to frighten parents about the epidemicâs threat to their children.
Epidemiologists, infectious disease specialists and public health authorities are in near-universal agreement that the current outbreak appears to pose low risk to kids at the moment. But as far-right figures tie the virus to baseless panic about LGBT people âgroomingâ children, and as some media outlets and online influencers speculate that monkeypox could flourish in school settings, those assurances risk being drowned out.
âThe few kids infected have been close household contacts of cases,â emphasized Dr. David Freedman, a professor emeritus of infectious diseases at the University of Alabama and an expert in tropical diseases. âI just donât think that silent carriage into a school setting is a big risk unless guidelines are completely ignored.â
The tangle of unintentional misinformation and purposeful disinformation has grown in recent weeks as leading far-right conservative figures and conspiracy theorists have latched on to a handful of pediatric cases as proof that gay men are sexually abusing children on a mass scale.
âWho is raping kids in D.C.?â conspiracy activist and failed congressional candidate Laura Loomer wrote on Telegram last week, linking to an article confirming a case of monkeypox in an infant in the nationâs capital.
âHas any law enforcement agency investigated how those two kids got monkeypox yet? Or just, like...nah?â Michael Knowles, a conservative commentator at The Daily Wire who has accused teachers of âgroomingâ children if they do not disclose a childâs sexual orientation to the childâs family, tweeted in response to another pair of pediatric infections.
Those accusationsâpart troll, part continuation of a decades-long smear campaign against LGBT peopleâhave been bolstered by other, more well-meaning concerns expressed by parents and health activists who see the monkeypox outbreak as a potential successor to the COVID-19 pandemic.
Those activists and educators, like geneticist-slash-podcaster Spencer Wells, who predicted that âthis isnât going to be a fun school yearâ due to the risk of pediatric monkeypox, have seized on the long-held medical belief that childrenâwho do face a higher risk of complications from monkeypox infectionâspread the virus more easily, particularly in school settings. But the scientific understanding of monkeypoxâs contagiousness, methods of transmission and riskiness to certain populations have changed dramatically in recent years, experts told The Daily Beast, and kids may not face as much risk from infection as previously thought.
âThe European countries that have reported pediatric cases have reported one or two cases, and so the virus isnât spreading among kids,â said Dr. Kristina Bryant, a pediatric infectious disease specialist at the University of Louisville School of Medicine. âI really donât think we need to worry about this virus spreading in schools or daycare settings.â
Part of the misapprehension, said Dr. Abraar Karan, an infectious disease researcher at Stanford University, is rooted in out-of-date interpretation of data nearly half a century old. The current outbreak, Karan said, has forced public health officials to unlearn decades of knowledge about the virus, among them the previous bias that monkeypox was largely limited to children.
âKids will have close contactâtheyâll be touching a lot of surfaces, they wonât be washing and cleaning their hands, they have a lot of exposure to fomitesâwhereas adults are probably more diligent about what they touch, what they put in their mouth, whatâs on their hands, how often they wash their hands, that kind of thing,â Karan said, explaining the thinking behind a five-year study in the 1980s that found that nine in ten cases of the virus occurred in children younger than fifteen.
But recent reevaluations of that and similar surveys, infectious disease experts told The Daily Beast, indicate that those pediatric cases may not have actually proved a unique monkeypox risk to kids at all.
âIt is true that in countries where the virus was endemic, cases occurred in young children, and we know that kids under eight were at higher risk for severe disease. But even in endemic countries, the epidemiology of monkeypox has been changing,â said Bryant, who noted that the average age of patients with monkeypox has slowly risen in recent decades. âBack in the seventies, the average age was four or five years of ageâmore recently, it was late adolescents and young adults.â
Many epidemiologists are now coming to the conclusion that the reason monkeypox first appeared to affect only children was the result of another global public health emergency: smallpox. At the time of monkeypoxâs discovery, the world was just winding down a global smallpox eradication campaign, which saw nearly every person on the planet inoculated against the deadly illness. Both smallpox and monkeypox are orthopox viruses, which means that smallpox vaccines also prevent monkeypoxâhence the use of the two-dose Jynneos vaccine to inoculate high-risk people against the latter.
âThat may be another reason why the demographics skewed to people who are younger, even in other outbreaks,â said Karan. âThere was basically a vulnerable population as soon as we stopped widespread smallpox vaccination, so it was sort of a matter of time before this happened.â
That apparent shift in monkeypox epidemiology, experts suggested, means that public concern about spread in childcare or daycare facilitiesâwhether spread by anti-gay conspiracy theorists or anxious parents misreading the current science on the diseaseâcould be overblown.
âThereâs something weâre still not fully picking up or understanding about this outbreak,â said Karan, who noted that while most orthopox viruses, the family of viruses that includes smallpox and monkeypox, spread more easily amongst children than adults, the current outbreak isnât demonstrating that same trait.
âOrthopox viruses donât mutate this fast easily, and some some studies have shown that some of the strains that are going around have mutated a lot more than would have been expected,â Karan said. ââI think in regards to the epidemiology and transmission, weâre still learning a little bit about whatâs going on.â
Infectious disease specialists know better than most the risks of making authoritative declarations about unprecedented viral outbreaks, and are still waiting for the Centers for Disease Control and Prevention to issue science-based guidance on how to address cases in children. But even without such guidance, Bryant said, parents and educators may actually be better positioned than most to identify early cases, due to monkeypoxâs similarity to more common childhood illnesses.
âKids get a variety of infectious rashes that are much more common than monkeypox, so schools and daycares have protocols to keep kids who are sick home and away from other kids,â Bryant said. âThose protocols work really well.â