November 28, 2023

With the American monkeypox outbreak rampant, public health officials worry that outdated science and bad faith scapegoating are combining to scare parents about the threat of the outbreak to their children.

Epidemiologists, infectious disease specialists, and public health authorities almost universally agree that the current outbreak appears to pose a low risk to children at this time. But as far-right figures link the virus to unfounded panic about LGBT people “grooming” children, and as some media and online influencers speculate that monkeypox could flourish in school settings, those assurances risk they drown.

“The few children who were infected had close household contacts,” said Dr. David Friedman, emeritus professor of infectious diseases at the University of Alabama and an expert on tropical diseases. “I just don’t think the silent carry in a school setting is much of a risk unless the instructions are completely ignored.”

The tangle of unintentional misinformation and deliberate misinformation has grown in recent weeks as leading far-right conservative figures and conspiracy theorists have latched onto a handful of pediatric cases as evidence that gay men sexually abuse children on a massive scale.

“Who’s Raping Kids in DC?” conspiracy activist and failed congressional candidate Laura Loomer; he 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 these two children contracted monkey pox? Or just, like…huh?” Michael Knowles, a conservative commentator on The Daily Wire who has accused teachers of “grooming” children if they don’t disclose a child’s sexual orientation to his family, he tweeted in response to another pair of pediatric infections.

Those accusations—part troll, part continuation of a decade-long anti-LGBT smear campaign—have been bolstered by other, more well-intentioned concerns raised by parents and health activists who see the monkeypox outbreak as a potential successor to COVID-19 pandemic.

These activists and educators, like geneticist-slash-podcaster Spencer Wells, who predicted that “this is not going to be a fun school year” because of the risk of monkeypox, have seized on the long-standing medical belief that children—who face higher risk of complications from monkeypox infection—they spread the virus more easily, especially in school settings. But scientific understanding of monkeypox’s transmissibility, methods of transmission and risk in certain populations have changed dramatically in recent years, experts told The Daily Beast, and children may not be at as great a risk of infection as previously thought.

“European countries that have reported pediatric cases have reported one or two cases, so the virus is not spreading to children,” said Dr. Kristina Bryant, a pediatric infection 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 daycares.”

Part of the misunderstanding, said Dr. Abraar Karan, an infectious disease researcher at Stanford University, is rooted in antiquated interpretation of data from nearly half a century ago. The current outbreak, Karan said, has forced public health officials to unlearn decades of knowledge about the virus, including the earlier preconception that monkeypox was largely confined to children.

“Kids will have close contact—they’ll touch a lot of surfaces, they won’t wash and sanitize their hands, they’ll have a lot of exposure to filth—whereas adults are probably more careful about what they touch, what they put in their mouths them, what they have on their hands, how often they wash their hands, that sort of thing,” said Karan, explaining the thinking behind a five-year study in the 1980s that found that nine out of ten cases of the virus appeared in children under the age of fifteen.

But recent re-evaluations of this and similar studies, infectious disease experts told The Daily Beast, show that these pediatric cases may not have actually proven to be a unique monkeypox risk to children.

“It is true that in countries where the virus was endemic, cases occurred in young children and we know that children under the age of eight were at higher risk of severe disease. But even in endemic countries, the epidemiology of monkeypox has changed,” said Bryant, who noted that the average age of monkeypox patients has slowly increased in recent decades. “Back in the seventies, the average age was four or five years old – more recently, it’s been late teens and young adults.”

Many epidemiologists now conclude that the reason monkeypox first appeared to affect only children was the result of another global public health emergency: smallpox. At the time of the discovery of monkeypox, the world was just going through a global campaign to eradicate smallpox, which saw almost every person on the planet vaccinated against the deadly disease. Both smallpox and monkeypox are orthopoxviruses, which means that smallpox vaccines also prevent smallpox – hence the use of the two-dose Jynneos vaccine to vaccinate high-risk individuals against the latter.

“That may be another reason why the demographics shifted to people who are younger, even in other cases,” Karan said. “There was basically a vulnerable population once we stopped widespread smallpox vaccination, so it was just a matter of time before that happened.”

This apparent change in the epidemiology of monkeypox, experts suggested, means that public concern about its spread in nurseries or daycare centers—whether propagated by anti-gay conspiracy theorists or worried parents who misinterpret current science about disease- could be excessive.

“There is something we still don’t fully understand or understand about this outbreak,” said Karan, who noted that while most arthropod viruses, the family of viruses that includes smallpox and monkeypox spread more easily among children than among adults, the current epidemic does not exhibit the same characteristic.

“Orthopox viruses don’t mutate that quickly, and some studies have shown that some of the strains in circulation have mutated a lot more than you might expect,” Karan said. “I think in terms of epidemiology and transmission, we’re still learning quite a bit about what’s going on.”

Infectious disease experts know better than most the dangers of making authoritative statements about unprecedented viral outbreaks, and are still waiting for the Centers for Disease Control and Prevention to issue scientific guidance on how to deal with outbreaks in children. But even without such guidance, Bryant said, parents and educators may actually be in a better position than most to spot early cases because of monkeypox’s similarity to more common childhood illnesses.

“Children develop a variety of infectious rashes that are much more common than monkeypox, so schools and daycares have protocols in place to keep children who are sick at home and away from other children,” Bryant said. “These protocols work very well.”

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