Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 29, Number 2—February 2023
Research Letter

Familial Monkeypox Virus Infection Involving 2 Young Children

Author affiliations: Centre Hospitalier Intercommunal de Fréjus-Saint-Raphaël, Fréjus, France (P. Del Giudice, A. Fribourg, L. Roudiere, J. Gillon, M. Reverte); Agence Régionale de Santé, Toulon, France (A. Decoppet)

Cite This Article

Abstract

We report intrafamilial transmission of monkeypox virus to all members of a family (father, mother, and 2 children). Case reports in young children have been extremely rare during the 2022 mpox outbreak. Their clinical signs were mild, and clinical diagnosis would be difficult without knowledge of the father’s monkeypox virus infection.

Monkeypox virus (MPXV) is a zoonotic orthopox virus. An outbreak of MPXV infections emerged in the spring of 2022 outside Africa, mainly in Europe and the United States, such that on July 23, 2022, the World Health Organization declared the outbreak to be a public health emergency of international concern. During this outbreak, MPXV spread has disproportionately affected gay or bisexual men or other men who have sex with men, which suggests transmission through sexual or intimate contact. However, in August 2022, we observed intrafamilial transmission of the virus to all members of a family (father, mother, and 2 children) in France.

The father, a 30-year-old-man, showed a few papular pustules on his body, including his penis. The pustules began appearing on July 17, 2022. A pustule sample was tested for MPXV and showed a positive PCR result. The wife of the man showed a few pustules on August 2 that were later confirmed to be positive for MPXV by PCR. She had no mucous signs. Both persons were HIV negative.

Figure 1

Figure. Monkeypox virus lesions for the 4-year old daughter in a family (father, mother, 2 children) infected with the virus, August 6, 2022. A) Umbilical pustule on pulp of the finger; B) papulopustule on the ankle; C, D) faint erythematous rash on the thighs.

Figure 1. Figure.Monkeypox virus lesions for the 4-year old daughter in a family (father, mother, 2 children) infected with the virus, August 6, 2022. A) Umbilical pustule...

The couple and their 2 young daughters went on vacation to a campsite in southern France on August 6. Their 4-year-old daughter had a fever (temperature 38°C) and a skin eruption that began on August 5, which consisted of 3 types of lesions: an umbilical pustule (Figure, panel A), papular pustules on an erythematous basis (Figure, panel B), and a disseminated faint erythematous macula (Figure, panels C, D). She also had a bilateral conjunctivitis but no lymphadenopathy or mucosal lesions.

On August 9, her 7-year-old sister showed ≈10 asymptomatic micropapular pustules on a discrete erythematous basis (Appendix Figure 1). She had no fever, mucosal lesion, or lymphadenopathy.

The family was residing at a campsite in southern France, where there is a high burden of Aedes albopictus mosquitoes. They were suspected of having either MPXV infection or Aedes sp. mosquito bites. A skin scraping from the skin of a micropapular pustule was positive for MPXV by PCR. For all family members, only 1 lesion/person was sampled. Onset symptoms and positive PCR results are shown in the timeline (Appendix Figure 2). The family received isolation instructions and returned home on August 11. The outcome was favorable for all 4 persons. There were no secondary cases at the campsite.

During the ongoing outbreak, cases of MPXV infection in young children have been extremely rare. US data from the Centers for Disease Control and Prevention as of October 7, 2022, reported 26,577 cases in 28 patients (0.1%) <12 years of age (1,2). Those data were confirmed in Europe. As of August 3, 2022, among 4,663 laboratory-confirmed cases of MPXV infection reported in Spain, only 4 (0.1%) were in children <4 years of age (7, 10, and 13 months, and 3 years) and 12 were in adolescents 13‒17 years of age (3). As of August 23, 2022, a total of 41 countries in the World Health Organization European Region have reported 21,098 cases, of which 15 (0.07%) were in persons <15 years of age (4).

Intrafamilial transmission to all family members including both children, also appears extremely rare in the 2022 outbreak. We assume that the transmission route was through household direct skin-to-skin contact with their parents.

The clinical signs shown by the children were mild, and clinical diagnosis would be extremely difficult in the absence of knowledge of the MPXV infection of the father. Case reports in young children have been extremely rare in this outbreak (57). Thus, a dermatologic description is lacking in this population. The 2 children in this report had mild general signs. Skin lesions consisted of a few umbilical pustules or papulopustules similar to those reported (810). However, the children also had discrete micropapular pustules on an erythematous basis similar to mosquito bites and a faint erythematous rash. Such skin lesions have rarely been reported in children or adults (810).

Dr. Del Giudice is a physician in the Infectious Diseases and Dermatology Unit at Bonnet Hospital, Fréjus, France. His primary research interest is skin infections.

Top

Acknowledgment

We thank Moussa Hajer for editing the figures, proofreading, and submitting this manuscript.

Top

References

  1. Centers for Disease Control and Prevention. Monkeypox cases by age and gender, race/ethnicity, and symptoms [cited 2022 Dec 1]. https://www.cdc.gov/poxvirus/monkeypox/response/2022/demographics.html
  2. Hennessee  I, Shelus  V, McArdle  CE, Wolf  M, Schatzman  S, Carpenter  A, et al.; California Department of Public Health Monkeypox Pediatric Working Group. CDC Monkeypox Pediatric Working Group. Epidemiologic and clinical features of children and adolescents aged <18 years with monkeypox—United States, May 17–September 24, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:140711. DOIPubMedGoogle Scholar
  3. Aguilera-Alonso  D, Alonso-Cadenas  JA, Roguera-Sopena  M, Lorusso  N, Miguel  LGS, Calvo  C. Monkeypox virus infections in children in Spain during the first months of the 2022 outbreak. Lancet Child Adolesc Health. 2022;6:e223. DOIPubMedGoogle Scholar
  4. Vaughan  AM, Cenciarelli  O, Colombe  S, Alves de Sousa  L, Fischer  N, Gossner  CM, et al. A large multi-country outbreak of monkeypox across 41 countries in the WHO European Region, 7 March to 23 August 2022. Euro Surveill. 2022;27:2200620. DOIPubMedGoogle Scholar
  5. Tutu van Furth  AM, van der Kuip  M, van Els  AL, Fievez  LC, van Rijckevorsel  GG, van den Ouden  A, et al. Paediatric monkeypox patient with unknown source of infection, the Netherlands, June 2022. Euro Surveill. 2022;27:2200552. DOIPubMedGoogle Scholar
  6. Ramnarayan  P, Mitting  R, Whittaker  E, Marcolin  M, O’Regan  C, Sinha  R, et al.; NHS England High Consequence Infectious Diseases (Airborne) Network. Neonatal Monkeypox Virus Infection. N Engl J Med. 2022;387:161820. DOIPubMedGoogle Scholar
  7. Fuente  SM, Nava  FB, Valerio  M, Veintimilla  C, Aguilera-Alonso  D. A call for attention: pediatric monkeypox case in a context of changing epidemiology. Pediatr Infect Dis J. 2022;41:e5489. DOIPubMedGoogle Scholar
  8. Thornhill  JP, Barkati  S, Walmsley  S, Rockstroh  J, Antinori  A, Harrison  LB, et al.; SHARE-net Clinical Group. Monkeypox virus infection in humans across 16 countries, April‒June 2022. N Engl J Med. 2022;387:67991. DOIPubMedGoogle Scholar
  9. Girometti  N, Byrne  R, Bracchi  M, Heskin  J, McOwan  A, Tittle  V, et al. Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis. Lancet Infect Dis. 2022;22:13218. DOIPubMedGoogle Scholar
  10. Tarín-Vicente  EJ, Alemany  A, Agud-Dios  M, Ubals  M, Suñer  C, Antón  A, et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. Lancet. 2022;400:6619. DOIPubMedGoogle Scholar

Top

Figure

Top

Cite This Article

DOI: 10.3201/eid2902.221674

Original Publication Date: December 23, 2022

Table of Contents – Volume 29, Number 2—February 2023

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Pascal Del Giudice, Infectiology and Dermatology Unit, Centre Hospitalier Intercommunal de Fréjus-Saint-Raphaël, Fréjus, France

Send To

10000 character(s) remaining.

Top

Page created: December 01, 2022
Page updated: January 21, 2023
Page reviewed: January 21, 2023
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external