Monkeypox at school: should students and parents be worried?

In the meantime, the students are going back to school. Parents, caregivers, teachers and students have many questions. Can monkeypox be spread by sitting next to someone with the virus in a classroom or playing together in the playground? Could it be transmitted by sharing food or drink? Are there certain activities for K-12 students that pose a higher risk? And for college students? And what about the risk of other infectious diseases?

Dr AS Leana Wen: Monkeypox is transmitted primarily through prolonged, direct, skin-to-skin contact with a person who is actively shedding the virus. It is associated with intimate sexual activity but can be spread through other close contact, such as kissing and hugging. The first groups affected were gays, bisexuals and other men who have sex with men. A study recently published by the CDC found that 99% of cases were in men, with 94% reporting recent sexual or intimate contact between men.
This contrasts with another disease that we have talked about a lot in the past two years, Covid-19. Covid-19 is caused by an airborne virus it is extremely contagious. You could catch Covid-19 by talking with someone or simply sharing the same air with someone who is in the same room as you. Monkeypox can be spread through certain objects – for example, bedding, towels and utensils used by an infected person – but this is a much less common route of transmission than direct contact.

CNN: Let’s talk about some examples of common school scenarios. Can monkeypox be spread by sitting next to someone in a classroom or riding the bus together?

So far, transmission of monkeypox has not occurred among children in the United States, according to CNN medical analyst Dr. Leana Wen.

Magnifying glass: It is extremely unlikely. Monkeypox is not transmitted simply by sitting next to a person. Again, it’s not Covid-19 – this virus is not as contagious.

CNN: What about kids playing together on the playground? Would touching the same objects put them at risk of transmission of monkeypox?

Magnifying glass: In theory, it’s possible that a child with an exposed rash could touch another child while playing together. Small children also put objects in their mouths which could then be touched by other children, and transmission could occur that way.

I’m not worried about my two young children, ages 2 and 5, who get monkeypox because so far it hasn’t spread among children in the United States. There are some isolated reports of children with monkeypox, but no reports of children passing on to each other. The incidence of monkeypox in children is currently so low that I am not worried about it spreading while my children are in preschool and kindergarten.

That could change if outbreaks start happening in children, but that’s not what we’ve seen so far.

The incidence of monkeypox in children is low, so students playing contact sports shouldn't be a big concern, Wen said.

CNN: Could monkeypox be spread by sharing drinks or food?

Magnifying glass: Yes. Again, this is a lower risk than other close activities previously discussed such as sexual activity, but sharing drinks or food is a possible method of transmission. People infected with monkeypox should not share utensils, food, or drink with others.

CNN: You said earlier that it can spread through sheets and towels. Should parents and caregivers be worried about their children trying on clothes and avoiding travel to hotels?

Magnifying glass: I do not think so. If someone is infected with monkeypox, they can spread the virus on their clothes and other objects that touch their rash, such as sheets, towels, and other linens. If a member of your family has monkeypox, no one should share their clothes or bed.

But it’s very different from going so far as to avoid trying on clothes at the mall or staying in hotels. Of course, there is a theoretical possibility that the person who just tried on the same clothes had monkeypox and left the virus on the clothes, but the odds of that happening are very low. The same goes for hotels, where sheets and towels have to be replaced between guests anyway.

CNN: Are there certain activities for K-12 students that pose a higher risk?

Magnifying glass: Activities that involve prolonged skin-to-skin contact will present a higher risk. Children involved in wrestling or football, for example, would be at greater risk than if they were involved in running or swimming.

This does not mean that children should not participate in contact sports. Again, the incidence of monkeypox in children is currently so low that it should not be a major concern.

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Some students at school are sexually active. I would worry about these students, especially those who have multiple partners or have sex with people they don’t know well, because it is through such intimate activity that monkeypox is primarily spread.

CNN: This brings me to students. What are high-risk activities for them and what precautions should they take?

Magnifying glass: Let’s review the activities by level of risk. The highest risk would be sex with multiple partners. Intimate activities like kissing and cuddling with multiple people would also be high risk.

Sharing drinks, food, and objects like cigarettes and vapes could also lead to transmission of monkeypox, although this risk is lower. Transmission of monkeypox has also been documented in individuals dancing for long periods of time in close quarters with many other people, particularly if most individuals do not wear clothing over parts of their body, resulting in more skin-to-skin contact.

Being platonic roommates with someone is less risky, as is playing most sports. Other daily activities, such as going to class, dining with peers, and socializing with friends, are extremely low risk. Teaching staff, professors and other school and university personnel are at extremely low risk if they do not have direct skin-to-skin contact with students or each other.

CNN: What precautions would you advise students to take?

Magnifying glass: Know which activities pose the highest risk and try to reduce your risk. Since sexual activity is the most risky, consider reducing the number of sexual partners until you are vaccinated. Before engaging in intimate activity, ask if the other person has had any new or unexpected rashes – and, if possible, consider exchanging contact information with new sexual partners in case you or they develop more symptoms late. Try not to share drinks, food, or cigarettes with multiple strangers. If you go to nightclubs or bars where you expect to be very close with many people, consider wearing long sleeves and pants to cover areas that will be in close contact with others.

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I also urge everyone to know the signs and symptoms to watch out for. In most cases, monkeypox presents as fever, swollen lymph nodes, and a rash that results in the formation of blisters. However, fever and swollen lymph nodes may not always be present. You might also have just one or two small rashes anywhere on your body. Monkeypox can also present as sores in the mouth, on the genitals, or in the anus. If you have any of these symptoms, get tested.

This reminds me – students need to know where to go for tests. Many colleges will offer on-site testing. Others will recommend that you visit a nearby commercial lab. Colleges should all have isolation procedures in place. It would be useful to know what they are in advance so that you are not caught off guard in case you test positive.

Finally, students who are eligible to be vaccinated should do so. The CDC has eligibility suggestions. Check with your local health department and sexual health clinics in your area. The availability of vaccines and how to access them will differ depending on the part of the country. My strong advice to people responding to the CDC’s eligibility suggestions is to get vaccinated if you can – it will reduce your chances of getting infected and passing monkeypox on to others.

CNN: Overview – how should parents, caregivers, teachers and students consider the risk of monkeypox along with the risk of other infectious diseases?

Magnifying glass: This differs by age group. For anyone not yet sexually active, the risk is very low, given the populations affected by monkeypox so far. The community living environments at collegecombined with high-risk activities, makes monkeypox a much greater concern for students in this age group.

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