Monkey pox at nursery was ‘only a matter of time’, says expert. Next: pools, sports, schools

‘It was only a matter of time’ before monkeypox reached congregate environments, says pediatric infectious disease specialist Luckafter Illinois State officials announced Friday that a daycare worker had been diagnosed with the virus associated with smallpox.

“There is definitely a potential for monkeypox to spread” in daycare centers, schools, college campuses, prisons and other similar settings, said Dr. Alexandra Brugler Yonts, an infectious disease specialist at Children’s National Hospital in Washington, DC. He helped lead the FDA review of Jynneos—one of two smallpox vaccines licensed to treat smallpox and by far the safer of the two.

“Anywhere that close physical skin-to-skin contact occurs — particularly of people in various stages of undress — there’s a risk,” he said.

All children and adults at the unidentified daycare center in Champaign County, Illinois, were tested and no additional cases were identified, state health officials said Friday, adding that Gov. JB Pritzker had been in contact with the White House about the situation.

But schools and living spaces aren’t the only settings ripe for diffusion, Brugler Yonts said. Also on her list of places where transmission could occur: swimming pools and water parks — “not through the water, but through bumping into someone with active lesions — especially in the summer, given the heat and the tendency to minimize clothing.”

Contact sports such as football and wrestling can also prove problematic, he added.

“We hope that outbreaks can be contained more locally, but as people continue to travel, join the [aforementioned] activities and then with school starting soon…. I think this will be more common. There have already been cases in almost every state in the US.”

As of Friday, 7,510 cases had been identified in the US, with the most cases in New York, California and Florida, according to data from the US Centers for Disease Control and Prevention. Every state except Wyoming and Montana has had cases.

More than 28,000 cases have been reported worldwide since January, almost all in countries where monkeypox is not considered endemic, according to the CDC. The US now leads the world in detected cases, followed by Spain, Germany, the UK, France and Brazil. Only 345 cases have been seen since January in African countries where the virus is considered endemic. Eighty-one children had been infected since late July, according to the World Health Organization.

Illinois health officials said Friday that the U.S. Food and Drug Administration approved the use of Jynneos, licensed for use in adults 18 and older, for potentially affected children at the center “without jumping through normal hoops.” Mobile testing and vaccination services were in place, they added.

An FDA spokesman told Fortune via email Friday that the vaccine is approved for such children through an “expanded access application for a single patient investigation” submitted for each. Applications are processed “as soon as practicable” and approved “when there are no comparable or satisfactory alternatives and are requested by the treating licensed physicians, who determine whether the benefits outweigh the potential [sic] danger.”

The spokesman did not comment further on the possibility of general approval for the use of Jynneos in children.

Because Jynneos is licensed, not just authorized under an emergency use authorization like the original COVID vaccines were, it can be used “off-label”—for example, in exposed children, Brugler Yonts said.

Researchers “will certainly want to collect safety and, if possible, immunogenicity data for these children and follow them closely, as there is no preexisting data for use in the pediatric population,” he said. “But Jynneos is safe, and if this can prevent a larger outbreak in the pediatric population – and of course the adults who care for them and live with them – that’s very important.”

The decision to give the vaccine to children is “worth the potential risk,” he added.

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