Florida infant, New Hampshire child contract monkeypox

Rash on feet and ankles of baby
Rash on feet and ankles of baby

Tutye / iStock

A Florida infant and a child from New Hampshire represent the latest reported pediatric monkeypox infections, and both cases highlight the role that household contacts and surface contamination could play in monkeypox exposure.

Today in Morbidity and Mortality Weekly Report, authors describe a Florida infant who contracted monkeypox and presented to the emergency room with a distinct rash that developed into cellulitis. The infant—who had four caregivers—was administered intravenous antibiotics for secondary bacterial cellulitis associated with having scratched a lesion on the arm.

Ten days after rash onset, the infant tested positive for monkeypox. The baby never developed a fever and his or her condition did not worsen. Eye drops were administered, however, as some rash pustules developed on the eyelid.

Caregiver exposure for infant

The infant had no travel history and did not attend outside childcares, but lived with four care givers, one of whom (caregiver B), "reported activities that placed him at high risk for monkeypox exposure during the 2 months preceding the infant's illness."

"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 authors of the study said close skin-to-skin contact or contaminated bed linens were likely the route of transmission in this household. The other caregivers in the house received prophylactic doses of the Jynneos vaccine, and none developed symptoms in the 21 days following the infant's illness.

In New Hampshire, a child in Manchester also contracted the virus after an identified exposure to a household contact diagnosed as having monkeypox.

To date, 27 confirmed cases of monkeypox in pediatric patients aged 0 to 15 years have been reported in the United States during the 2022 outbreak.

The Centers for Disease Control and Prevention (CDC) has reported 382 more monkeypox cases, raising the national total to 23,499 cases.

Viable monkeypox virus from surfaces

In a preprint study, researchers in Singapore report isolating viable monkeypox virus from surfaces and dust samples, but they obtained no viable virus from air and water samples from a patient's hospital room.

The study, which has not yet undergone peer review, was conducted by taking environmental samples in a negative pressure room with 12 unidirectional HEPA air changes per hour, and daily cleaning of the surfaces. A total of 179 environmental samples were collected on days 7, 8, 13, and 21 of his illness.

"Air, surface, and dust contamination was highest during the first eight days of the illness, with a gradual decline to the lowest contamination level by day 21," the authors said.

Also today, a case report describes a possible tattoo-transmitted monkeypox infection in Italy. The patient reportedly got a tattoo in Spain in the 7 days prior to rash development. The rash developed where the tattoo needle was inserted.

In another study, a Brazilian nurse who likely contracted the virus during a needle-stick event. A lesion appeared at the stick site 5 days after the event, and the nurse subsequently tested positive for the virus.

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