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Mpox (child care and schools)

What is mpox?

Mpox is a disease caused by infection with the monkeypox virus, which is a type of orthopoxvirus. Three are two types of mpox: clade I and clade II. Mpox symptoms typically last 2-4 weeks and generally resolve on their own. Sometimes mpox can cause painful skin lesions which may require pain management or other treatments. At this time, the risk of mpox to children and adolescents in the United States is low. Transmission among cases in the U.S., due to an outbreak of clade II that began in 2022, has been primarily associated with sexual contact; however mpox can infect anyone — including children — if they have close (generally skin-to-skin) contact with someone who has mpox. Vaccines for post-exposure prophylaxis and medicines for treatment are available when indicated. Clade I is currently circulating in central Africa and has been declared a Public Health Emergency of Interntional Concern by the World Health Organization. There have not been any clade I cases detected in the U.S. as of September of 2024. Vaccines and medical treatments are not anticipated to work differently for clade I. For more information on clade I, see CDC Clade I Mpox Outbreak Originating in Center Africa. 

Signs and symptoms

  • Rash that progresses from maculopapular lesions (flat spots to patches), to vesicles (blisters), pustules (pus-filled blisters), ulcers, and finally scabs. Skin lesions can be in various stages of progression at any given time. The rash may appear at any time in relation to other symptoms listed below (e.g., before, during, or after) and some people may only have a rash.
  • Fever/chills.        
  • Headache.
  • Muscle aches and backache.
  • Swollen glands (lymph nodes).
  • Profound fatigue.

Mpox is rare among children during the current clade II outbreak in the U.S. Rash can be confused with other rash illnesses that are seen in children, including scabies; varicella (chickenpox); hand, foot, and mouth disease; measles; molluscum contagiosum; herpes; syphilis (including congenital syphilis); allergic skin rashes; and drug eruptions. Co-infections with mpox are possible (e.g., scabies AND mpox presenting in the same child), so a full evaluation by a health care provider is important.

Mpox rash photos

mpox rash photos

Incubation period

3-17 days

Contagious period and transmission

  • People with mpox are contagious until the rash has fully healed — when scabs have fallen off and a fresh layer of new skin forms where a lesion had been. 
  • Mpox is spread through direct contact with the rash, scabs, or body fluids of someone with mpox. It can also be transmitted by exchanging respiratory secretions during prolonged, face-to-face contact, kissing, or during intimate skin-to-skin physical contact. 
  • Most cases of mpox in the current U.S. clade II outbreak are associated with sexual contact. Although less common in the current outbreak, mpox can also be transmitted by contact with contaminated objects (such as toys or eating utensils), fabrics (clothing, bedding, sleeping mats, or towels), and surfaces that have been used by someone with mpox. The virus can also be transmitted to a fetus through the placenta in people who are pregnant.

Public health reporting requirements

  • Confirmed cases of mpox are required to be reported to public health.
  • Schools and child care settings should also report suspected cases of mpox to public health if the person has a known exposure to a confirmed case of mpox or a travel history to a place experiencing a clade I mpox outbreak.
  • Report the infection to the facility director, school nurse, or child care health consultant. Child health concerns should be discussed with the school nurse or child care health consultant. 

Control of transmission

  • Consult with local or state public health on implementation of control measures if a case of mpox is identified. 
  • If a child or adolescent develops symptoms while in school, early childhood education, or other setting, and mpox is suspected:
    • The child should:
      • Be separated from other children or adolescents in a private space (such as an office).
      • Wear a well-fitting mask (if the child is at least aged 2 years). 
      • Be picked up by a parent/guardian/caregiver, so they can have a medical assessment. 
  • Avoid close, skin-to-skin contact with someone with a new unexplained rash. When mpox is suspected, continue to attend to the child in an age-appropriate manner as necessary using a well-fitting mask, gown/smock, and gloves until a caregiver arrives.
  • Avoid contact with bare skin, objects, and materials that a person with mpox has used. Wear a well-fitting mask, gown/smock, and gloves when handling these objects and materials. 
  • Teachers, staff, and children should wash their hands often with soap and water or use hand sanitizer, especially immediately after contact with a person with suspected mpox, or with potentially contaminated items. 
  • Clean and disinfect the area where the person with mpox spent time. 
    • Avoid activities that could spread dried material from lesions (e.g., use of fans, dry dusting, sweeping, or vacuuming) in these areas.
    • Perform disinfection using an EPA-registered disinfectant which may be found on EPA’s List Q. CDPHE has a list of commonly used, approved products. Follow the manufacturer’s directions for concentration, contact time, and care and handling. 
    • Linens should be handled while wearing a well fitted mask (respirator preferred), gown/smock, and gloves. Linens can be laundered using regular detergent and warm water (water should reach 140°F). Soiled laundry should be gently and promptly contained in a dedicated laundry bag and never be shaken or handled in a manner that may spread infectious material. 
    • Staff who are cleaning and disinfecting the environment where someone with mpox spent time or handled their linens should wear a well fitted mask (respirator preferred), gown/smock, and gloves. If a disposable gown is not available, clothing should fully cover the skin and then immediately be laundered.
    • Linens and clothing that cannot be laundered on site should be place immediately in a secure plastic bag and sent home with the child or caregiver to be laundered. 
  • Settings that have children or adolescents in residence, like boarding schools, overnight camps, or other residential environments, should follow considerations for congregate settings.

Vaccination

At this time, there is no need for widespread vaccination for mpox among children or staff at K-12 schools or early childhood settings. However, a vaccine is available following certain types of exposures that can help prevent mpox if it is given soon after exposure. Vaccination can be considered on an individual basis in consultation with a health care provider and the health department. CDPHE’s where to get vaccinated for mpox webpage provides more information on who should get vaccinated and locations in Colorado where the mpox vaccine can be received. 

Treatment

Children and adolescents with exposure to people with suspected or confirmed mpox may be eligible for post-exposure prophylaxis. Consult with public health for decisions regarding PEP. Vaccination after known or presumed exposure to someone with mpox should occur ideally within four days of exposure. Administration of Jynneos vaccine 4-14 days following exposure may still provide some protection against mpox. Other PEP options may be considered in very young infants and children.

Currently, there is no treatment approved specifically for mpox virus infections. However, antivirals, such as tecovirimat (TPOXX), may be recommended after evaluation by a health care provider and public health.

Exclusion

  • Exclusion decisions should be made in consultation with public health.
  • Generally exclude all children, staff, and caregivers with symptoms or a rash suspicious for mpox until an evaluation can take place with their primary care provider or other qualified health care provider. People without a health care provider can review CDPHE’s list of locations providing mpox testing. 
  • People with mpox should follow isolation and prevention practices until all scabs fall off, and a fresh layer of healthy skin forms. This may take as long as four weeks after symptoms begin. Caregivers should work with a health care provider and the local health department to decide when the child or adolescent can return to the educational setting.
  • Generally, staff or volunteers who have mpox should isolate and be restricted from the workplace according to CDC’s isolation and prevention practices. 
  • If children had close contact with someone with mpox, they can attend school and other school-related activities as long as they remain asymptomatic.
  • In some high-risk situations, it may be appropriate for exposed persons to limit their participation in certain activities and setting types with regular close or skin-to-skin contact. Consult with your local public health agency. 

Role of teachers, caregivers, and family

  • Susceptible pregnant teachers/caregivers and pregnant family and household members of children in child care and school settings should be particularly vigilant to avoid contact with people who have a suspicious rash or symptoms of mpox, or any other viral illness. 
    Follow recommendations of local public health. 
  • Work with public health to help identify close contacts when public health advises to do so.
    • Dissemination of any campus or facility-wide notifications should be strongly weighed against the possibility of inadvertently disclosing protected health information. Work with local public health to determine if and when this might be helpful. 

Resources

Mpox (CDC)