Should parents be concerned about monkeypox in schools?
(CNN) — Cases of monkeypox are on the rise in the United States and around the world, with the US Centers for Disease Control and Prevention (CDC) reporting more than 15,000 confirmed cases in United States until August 23. The Biden Administration is accelerating vaccine distribution efforts and increasing community outreach, including through community partnerships and physician and patient education.
Meanwhile, the students return to school. Parents, caregivers, teachers and students have many questions. Can you get monkeypox from sitting next to someone with the virus in a classroom or playing together on the playground? Can it be transmitted by sharing food or drinks? Are there certain activities of higher risk for primary and secondary students? And for college students? And what about the risk of other infectious diseases?
To help us with these questions, we spoke with Dr. Leana Wen, CNN Medical Analyst, ER Physician, and Professor of Health Policy and Management at George Washington University’s Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and a mother of two young children who start school next week.
CNN: Can you remind us how monkeypox is transmitted and who is at high risk?
Dr. Leana Wen: Monkeypox is transmitted primarily through direct and prolonged skin-to-skin contact with someone who is actively shedding the virus. It is associated with intimate sexual activity, but can be spread through other close contact, such as kissing and hugging. The first affected groups have been homosexuals, bisexuals and other men who have sex with men. A study recently published by the CDC has revealed that 99% of cases have occurred in men, and 94% have reported having recently had sexual intercourse or intimate contact with a man.
This contrasts with another disease that we have talked about a lot in the last two years: covid-19. Covid-19 is caused by an airborne virus that is extremely contagious. You can catch covid-19 by talking to someone or simply by sharing the same air with someone who is in the same room as you. Monkeypox can be spread through some objects, for example bedding, towels and utensils used by someone infected, but it is a much less common route of transmission than direct contact.
CNN: Let’s talk about some examples of common scenarios in school settings. Can you get monkeypox from sitting next to someone in a classroom or riding the bus together?
Wen: That is extremely unlikely. Monkeypox is not spread by simply sitting next to a person. Again, this is not covid-19, this virus is not that contagious.
CNN: What about kids playing together on the playground? Would touching the same objects put them at risk for monkeypox transmission?
Wen: In theory, it is possible that a child with an exposed rash could touch another child while playing. Young children also put objects in their mouths that could then be touched by other children, and transmission could occur that way.
I am not worried that my two young children, ages 2 and 5, will get monkeypox because, so far, it has not spread among children in the United States. There are a couple of isolated reports of children with monkeypox, but there are no reports of transmission between children. The incidence of monkeypox among children is currently so low that I am not concerned about contagion while my children are in preschool and kindergarten.
This could change if outbreaks start to occur in children, but that’s not what we’ve seen so far.
CNN: Could monkeypox be spread by sharing drinks or food?
Wen: Yes. Again, the risk is lower than other close activities, such as sexual activity, but sharing food or drinks is a possible method of transmission. People infected with monkeypox should not share utensils or food or drink with other people.
CNN: You’ve said before that it can be spread through sheets and towels. Should parents and caregivers worry about their children trying on clothes and avoiding hotel trips?
Wen: I do not think so. If someone is infected with monkeypox, they could shed the virus on their clothes and other things that touch their rash, such as sheets, towels, and other bedding. If someone in your family has monkeypox, no one should share their clothing or bed.
But that’s a far cry from trying on clothes at the mall or staying in hotels. Of course, there is a theoretical possibility that the person who has just tried on the same clothes has monkeypox and leaves the virus on the clothes, but the chances of that happening are very low. The same goes for hotels, where sheets and towels should be changed between guests anyway.
CNN: Are there certain activities for elementary school students that are at higher risk?
Wen: Activities involving prolonged skin contact are at higher risk. Kids who play wrestling or football, for example, are at greater risk than those who swim or run cross country.
That doesn’t mean kids shouldn’t participate in contact sports. Again, the incidence of monkeypox in children is currently so low that it should not be a major concern.
Some students at school are sexually active. My concern would be for those students, especially those who have multiple partners or have sexual encounters with people they don’t know well, as it is through such intimate activity that monkeypox is primarily spread.
CNN: That brings me to college students. What are high-risk activities for them and what precautions should they take?
Wen: Let’s review activities by level of risk. The highest risk would be sexual intercourse with multiple partners. Intimate activities, such as kissing and hugging with multiple people, are also high risk.
Sharing drinks, food, and objects such as cigarettes and vapes could also result in the transmission of monkeypox, although that risk is lower. Transmission of monkeypox has also been documented in individuals who dance for long periods of time indoors with numerous other people, especially if most individuals do not wear clothing over parts of their bodies, leading to a increased skin-to-skin contact.
Being platonic roommates with someone is a lower risk, as is participating in most sports. Other everyday activities, such as going to class, having dinner with classmates, and socializing with friends, are very low risk. Teaching staff, professors, and other school and college staff are at extremely low risk if they do not have direct skin-to-skin contact with students or each other.
CNN: What would you advise college students?
Wen: Know the activities with the highest risk and try to reduce it. Since sexual activity carries the highest risk, consider reducing the number of sexual partners until you are vaccinated. Before engaging in intimate activity, ask if the other person has had any new or unexpected rashes and, if possible, consider exchanging contact information with any new sexual partners in case you or she later develops symptoms. Try not to share drinks, food or cigarettes with multiple strangers. If you go to nightclubs or bars where you expect to be in close proximity to many people, consider wearing long sleeves and pants to cover the areas that will be in direct contact with others.
I also encourage everyone to be aware of the signs and symptoms to watch out for. In most cases, monkeypox presents as a fever, swollen lymph nodes, and a rash that then blisters. However, fever and swollen lymph nodes are not always present. It is also possible that there are only one or two small rashes on any part of the body. Monkeypox can also present as sores in the mouth, on the genitals, or in the anus. If you have any of these symptoms, get tested.
This reminds me that students need to know where to go to get tested. Many universities offer the possibility of taking the tests in their own facilities. Others will recommend that you go to a nearby commercial lab. All universities should have isolation procedures in place.
It helps to know what these are beforehand so you won’t be caught off guard if you test positive.
Lastly, students who are eligible to be vaccinated should do so. The CDC has suggestions for eligibility. Check with your local health department and sexual health clinics in your area. The availability of vaccines and how to access them will vary depending on the area of the country. My strongest advice to people who meet the CDC’s eligibility suggestions is to get the vaccine if you can – that will reduce your chance of getting infected and also of spreading monkeypox to others.
CNN: How should parents, caregivers, teachers and students consider the risk of monkeypox alongside the risk of other infectious diseases?
Wen: This differs by age group. For those who have not yet had any sexual activity, the risk is very low, considering the populations affected by monkeypox so far. Co-living environments on campus, combined with higher-risk activities, make monkeypox a much bigger concern for students in that age group.