With the American monkeypox outbreak in a state of uncontrolled spread, public health authorities are concerned that outdated science and bad-faith scapegoating are combining forces to frighten parents about the epidemic’s threat to their children.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 “grooming” children, and as some media outlets and online influencers speculate that monkeypox could flourish in school settings, those assurances risk being drowned out.
“The few kids infected have been close household contacts of cases,” emphasized Dr. David Freedman, a professor emeritus of infectious diseases at the University of Alabama and an expert in tropical diseases. “I just don’t think that silent carriage into a school setting is a big risk unless guidelines are completely ignored.”
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.
“Who is raping kids in D.C.?” 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 nation’s capital.
“Has any law enforcement agency investigated how those two kids got monkeypox yet? Or just, like...nah?” Michael Knowles, a conservative commentator at The Daily Wire who has accused teachers of “grooming” children if they do not disclose a child’s sexual orientation to the child’s family, tweeted in response to another pair of pediatric infections.
Those accusations—part troll, part continuation of a decades-long smear campaign against LGBT people—have 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.
New world record — More than 1,000 daily #monkeypox cases (7 days average). Those who said #MPXV would fizzle out soon are plain wrong. This fall school year will need radically new / more safety mitigations.
Figure by @Antonio_Caramia pic.twitter.com/U0hRlGLLOl
— Eric Feigl-Ding (@DrEricDing) August 2, 2022
Those activists and educators, like geneticist-slash-podcaster Spencer Wells, who predicted that “this isn’t going to be a fun school year” due to the risk of pediatric monkeypox, have seized on the long-held medical belief that children—who do face a higher risk of complications from monkeypox infection—spread the virus more easily, particularly in school settings. But the scientific understanding of monkeypox’s 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.
“The European countries that have reported pediatric cases have reported one or two cases, and so the virus isn’t spreading among kids,” said Dr. Kristina Bryant, a pediatric infectious disease specialist at the University of Louisville School of Medicine. “I really don’t think we need to worry about this virus spreading in schools or daycare settings.”
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.
“Kids will have close contact—they’ll be touching a lot of surfaces, they won’t be washing and cleaning their hands, they have a lot of exposure to fomites—whereas adults are probably more diligent about what they touch, what they put in their mouth, what’s on their hands, how often they wash their hands, that kind of thing,” 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.
“It 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,” said Bryant, who noted that the average age of patients with monkeypox has slowly risen in recent decades. “Back in the seventies, the average age was four or five years of age—more recently, it was late adolescents and young adults.”
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 monkeypox’s 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 monkeypox—hence the use of the two-dose Jynneos vaccine to inoculate high-risk people against the latter.
“That may be another reason why the demographics skewed to people who are younger, even in other outbreaks,” said Karan. “There 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.”
That apparent shift in monkeypox epidemiology, experts suggested, means that public concern about spread in childcare or daycare facilities—whether spread by anti-gay conspiracy theorists or anxious parents misreading the current science on the disease—could be overblown.
“There’s something we’re still not fully picking up or understanding about this outbreak,” 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 isn’t demonstrating that same trait.
“Orthopox viruses don’t 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,” Karan said. ““I think in regards to the epidemiology and transmission, we’re still learning a little bit about what’s going on.”
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 monkeypox’s similarity to more common childhood illnesses.
“Kids 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,” Bryant said. “Those protocols work really well.”