What should schools do about monkeypox? New CDC guidelines weigh in
Schools and child care centers generally do not need to take extra steps to curb the spread of monkeypox, the Centers for Disease Control and Prevention says. It advises that they can rely on "their everyday operational guidance" to do things like ensure handwashing and clean surfaces, which help reduce the risk of potential cases from the outbreak this fall.
The agency's new recommendations were published in a series of Frequently Asked Questions on the CDC's website, and come as local health departments across the country are issuing their own recommendations for schools as students return to the classroom.
"At this time, the risk of monkeypox to children and adolescents in the United States is low," the CDC's guidance says.
As of Monday, the CDC counted more than 15,000 infections nationwide. Every state now has at least one case of monkeypox; 23 states and the District of Columbia have reported more than a hundred infections.
But only a small fraction of infections have been spotted in school-age kids so far. Demographic data published Monday by the agency, based on analysis of nearly 70% of reported cases, show just six cases are in children 0 to 5 years old, seven are in children 6 to 10 years old, and four are in children 11 to 15 years old.
"I think CDC put together this guidance, it seems to me, because of questions that were coming from the public. And that's a very valid reason to get information out. If people are looking for answers, that's a big part of what CDC does," said Dr. David Kimberlin, co-director of the division of pediatric infectious diseases at the University of Alabama at Birmingham.
Kimberlin is the editor of the "Red Book" published by the American Academy of Pediatrics to provide guidance to doctors on infectious diseases in children, including monkeypox.
He said he agreed with the CDC's recommendations, describing the risk that children might catch monkeypox at school as "vanishingly low."
Symptoms are largely similar for children infected with monkeypox as in adults, although the CDC says that young children under 8 years old may be at "especially increased risk for severe outcomes from monkeypox disease."
Since early in the outbreak, health officials have said the vast majority of monkeypox infections appear to be the result of intimate contact, or shared linens and towels, among adult men who have sex with men.
"This is not COVID. It is not an easy virus to catch. It requires a lot of up close, skin-to-skin contact. And with some basic kind of mitigation efforts, which I think is outlined quite well in the CDC webpage, the risk to a child is just not going to be there," Kimberlin said.
The CDC says that children generally do not need to be blocked from the classroom while monitoring for symptoms after coming into close contact with an infected person, like a parent or caregiver.
"It is important to treat the child and family in a non-stigmatizing manner and remember that monkeypox can transmit through close contact, which may include, but is not limited to, sexual activity. Most children who have caregivers with monkeypox should be able to attend school and other programs," the guidance says.
This echoes the agency's advice for the broader community, which does not recommend restrictions on a close contact's daily routines as long as they have not developed symptoms of the disease.
Local health departments battling a surge in monkeypox cases have issued similar guidance for their schools in recent weeks.
In San Francisco, the health department said in a statement that their recommendations, published on August 15, "include standard infection control policies and procedures."
However, San Francisco is urging school staff and families to learn about the disease "so they can remain vigilant about their own symptoms and risk factors." Monkeypox's lesions can be easily mistaken for rashes or other conditions more common in children, like chickenpox or hand, foot, and mouth disease, the city says.
Officials in Chicago pointed to their state's own interim guidance for schools, last updated on August 19, which also says that "asymptomatic exposed individuals do not need to stay home from school unless recommended by the local health department due to high-risk exposure."
Illinois schools could ask to confirm whether staff and students are free from monkeypox symptoms in the days following an exposure, the guidance suggests.
"It is important to note that as of Monday, August 22, there have been zero cases of Chicagoans aged 17 and under," Chicago's Department of Public Health said in a statement.
Earlier this month, local health officials in the Illinois town of Rantoul reported a monkeypox infection in a county day care worker. But no additional infections have been identified in the day care as a result of close contact with that person.
At least one case has been identified at a high school in Las Vegas, which started their semester earlier this month.
"Monkeypox transmission in school settings is not common and the Health District believes the risk of transmission at the school is low," a spokesperson for the Southern Nevada Health District said in a statement.
The agency declined to offer additional details about the Las Vegas case, which is now being investigated.