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During the 2022 mpox outbreak in Europe, primarily affecting men who have sex with men, a limited number of cases among children and adolescents were identified. Paediatric cases from outbreaks in endemic countries have been associated with a higher likelihood of severe illness. Detailed clinical case descriptions and interventions in school settings before 2022 are limited.


To describe clinical characteristics of mpox cases among children (< 15 years) and adolescents (15–17 years) in the greater Paris area in France, and infection control measures in schools.


We describe all notified laboratory-confirmed and non-laboratory-confirmed cases among children and adolescents identified from May 2022 to July 2023, including demographic and clinical characterisation and infection control measures in school settings, i.e. contact tracing, contact vaccination, secondary attack rate and post-exposure vaccination uptake.


Nineteen cases were notified (13 children, 6 adolescents). Four adolescent cases reported sexual contact before symptom onset. Ten child cases were secondary cases of adult patients; three cases were cryptic, with vesicles on hands, arms and/or legs and one case additionally presented with genitoanal lesions. Five cases attended school during their infectious period, with 160 at-risk contacts identified, and one secondary case. Five at-risk contacts were vaccinated following exposure.


Cases among children and adolescents are infrequent but require a careful approach to identify the source of infection and ensure infection control measures. We advocate a ‘contact warning’ strategy vs ‘contact tracing’ in order to prevent alarm and stigma. Low post-exposure vaccination rates are expected.


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  1. 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(36):2200620.  https://doi.org/10.2807/1560-7917.ES.2022.27.36.2200620  PMID: 36082686 
  2. Santé publique France (SpF). Monkeypox 2023. Paris: Santé Publique France [Accessed: 5 Sep 2023]. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/monkeypox/donnees/#tabs
  3. Haute Autorité de Santé (HAS). Avis n°2022.0034/SESP du 20 mai 2022 du collège de la Haute Autorité de santé relatif à la vaccination contre le virus Monkeypox. [High Authority of Health advice n°2022.0034/SESP of May 20, 2022 relating to vaccination against mpox virus]. Saint-Denis La Plaine: HAS; 2022. French. Available from: https://www.has-sante.fr/upload/docs/application/pdf/2022-05/avis_n2022.0034_sespev_du_20_mai_2022_du_college_de_la_has_relatif_a_la_vaccination_contre_la_variole_du_singe_monkeypox_vir.pdf
  4. Haute Autorité de Santé. Monkeypox: la stratégie vaccinale réactive précisée pour les primo-vaccinés et les enfants. [Monkeypox: the reactive vaccine strategy specified for non-vaccinated adults and children]. Paris: Haute Autorité de Santé; 2022. French. Available from: https://www.has-sante.fr/jcms/p_3345056/fr/monkeypox-la-strategie-vaccinale-reactive-precisee-pour-les-primo-vaccines-et-les-enfants
  5. Krug C, Tarantola A, Chazelle E, Fougère E, Velter A, Guinard A, et al. Mpox outbreak in France: epidemiological characteristics and sexual behaviour of cases aged 15 years or older, 2022. Euro Surveill. 2023;28(50):2200923.  https://doi.org/10.2807/1560-7917.ES.2023.28.50.2200923  PMID: 38099346 
  6. Ministère de la Santé et de la Prévention. Cas de Monkeypox en Europe, définitions et conduite à tenir, 8 juillet 2022. Cases of Monkeypox in Europe, case definitions and management, 8 July 2022. Saint-Maurice: Santé publique France. [Accessed: 13 May 2023]. Available from: https://www.sfm-microbiologie.org/wp-content/uploads/2022/08/2022_MaJ-08-07_MKP_DefK__CAT_SPF-1.pdf
  7. Mitjà O, Ogoina D, Titanji BK, Galvan C, Muyembe JJ, Marks M, et al. Monkeypox. Lancet. 2023;401(10370):60-74.  https://doi.org/10.1016/S0140-6736(22)02075-X  PMID: 36403582 
  8. Sukhdeo S, Mishra S, Walmsley S. Human monkeypox: a comparison of the characteristics of the new epidemic to the endemic disease. BMC Infect Dis. 2022;22(1):928.  https://doi.org/10.1186/s12879-022-07900-7  PMID: 36503476 
  9. Fenner F, Henderson D, Arita I, Jezek Z, Ladnyj I. Chapter 29 Human Monkeypox and other poxvirus infections of man. In: Smallpox and its eradication. World Health Organization; 1988. p. 1287-319.
  10. Beeson AM, Haston J, McCormick DW, Reynolds M, Chatham-Stephens K, McCollum AM, et al. Mpox in children and adolescents: epidemiology, clinical features, diagnosis, and management. Pediatrics. 2023;151(2):e2022060179.  https://doi.org/10.1542/peds.2022-060179  PMID: 36471498 
  11. Suvvari TK, Sandeep M, Kumar J, Satapathy P, Chenchula S, Gandhi AP, et al. A meta-analysis and mapping of global mpox infection among children and adolescents. Rev Med Virol. 2023;33(5):e2472.  https://doi.org/10.1002/rmv.2472  PMID: 37529964 
  12. Sam-Agudu NA, Martyn-Dickens C, Ewa AU. A global update of mpox (monkeypox) in children. Curr Opin Pediatr. 2023;35(2):193-200.  https://doi.org/10.1097/MOP.0000000000001232  PMID: 36809304 
  13. Khalil A, Samara A, O’Brien P, Ladhani SN. Treatment and prevention of mpox in pregnant people and young children. Lancet Infect Dis. 2023;23(4):396-7.  https://doi.org/10.1016/S1473-3099(23)00054-3  PMID: 36739884 
  14. Li Y, Zhao H, Wilkins K, Hughes C, Damon IK. Real-time PCR assays for the specific detection of monkeypox virus West African and Congo Basin strain DNA. J Virol Methods. 2010;169(1):223-7.  https://doi.org/10.1016/j.jviromet.2010.07.012  PMID: 20643162 
  15. Hennessee I, Shelus V, McArdle CE, Wolf M, Schatzman S, Carpenter A, et al. 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(44):1407-11.  https://doi.org/10.15585/mmwr.mm7144a4  PMID: 36331124 
  16. European Centre for Disease Prevention and Control (ECDC) and WHO Regional Office for Europe. (WHO-Europe). Mpox, Joint Epidemiological overview, 18 April 2024. Stockholm and Copenhagen: ECDC/WHO-Europe; 2024. Available from: https://monkeypoxreport.ecdc.europa.eu
  17. Satapathy P, Mohanty P, Manna S, Shamim MA, Rao PP, Aggarwal AK, et al. Potentially asymptomatic infection of monkeypox virus: a systematic review and meta-analysis. Vaccines (Basel). 2022;10(12):2083.  https://doi.org/10.3390/vaccines10122083  PMID: 36560493 
  18. Rossotti R, Calzavara D, Cernuschi M, D’Amico F, De Bona A, Repossi R, et al. Detection of asymptomatic mpox carriers among high-ri men who have sex with men: a prospective analysis. Pathogens. 2023;12(6):798.  https://doi.org/10.3390/pathogens12060798  PMID: 37375488 
  19. Hoxha A, Kerr SM, Laurenson-Schafer H, Sklenovská N, Mirembe BB, Nezu IH, et al. Mpox in children and adolescents during multicountry outbreak, 2022-2023. Emerg Infect Dis. 2023;29(10):2125-9.  https://doi.org/10.3201/eid2910.230516  PMID: 37647121 
  20. 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(11):e22-3.  https://doi.org/10.1016/S2352-4642(22)00250-4  PMID: 36058226 
  21. Jezek Z, Marennikova SS, Mutumbo M, Nakano JH, Paluku KM, Szczeniowski M. Human monkeypox: a study of 2,510 contacts of 214 patients. J Infect Dis. 1986;154(4):551-5.  https://doi.org/10.1093/infdis/154.4.551  PMID: 3018091 
  22. Santé publique France (SpF). Bilan du suivi des contacts à risque des cas probables et confirmés d’infection par le virus Monkeypox, mai – juillet 2022. [Assessment of at-risk contacts follow-up of probable and confirmed cases of Monkeypox virus infection in France, May – July 2022]. Saint-Maurice: SpF; 2022. French. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-transmissibles-de-l-animal-a-l-homme/monkeypox/documents/rapport-synthese/bilan-du-suivi-des-contacts-a-risque-des-cas-probables-et-confirmes-d-infection-par-le-virus-monkeypox-mai-juillet-2022
  23. Ladhani SN, Aiano F, Edwards DS, Perkins S, Khan WM, Iyanger N, et al. Very low risk of monkeypox among staff and students after exposure to a confirmed case in educational settings, England, May to July 2022. Euro Surveill. 2022;27(40):2200734.  https://doi.org/10.2807/1560-7917.ES.2022.27.40.2200734  PMID: 36205169 
  24. 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(10353):661-9.  https://doi.org/10.1016/S0140-6736(22)01436-2  PMID: 35952705 
  25. Moschese D, Giacomelli A, Mileto D, Antinori S, Bianchi M, Capetti AF, et al. Ongoing sporadic monkeypox cases: neutralising antibody detection in asymptomatic individuals. Lancet Microbe. 2023;4(10):e765.  https://doi.org/10.1016/S2666-5247(23)00185-4  PMID: 37385285 
  26. Amzat J, Kanmodi KK, Aminu K, Egbedina EA. School-based interventions on Mpox: A scoping review. Health Sci Rep. 2023;6(6):e1334.  https://doi.org/10.1002/hsr2.1334  PMID: 37313531 
  27. Girón-Guzmán I, Díaz-Reolid A, Truchado P, Carcereny A, García-Pedemonte D, Hernáez B, et al. Spanish wastewater reveals the current spread of Monkeypox virus. Water Res. 2023;231:119621.  https://doi.org/10.1016/j.watres.2023.119621  PMID: 36693290 
  28. Reda A, El-Qushayri AE, Shah J. Asymptomatic monkeypox infection: a call for greater control of infection and transmission. Lancet Microbe. 2023;4(1):e15-6.  https://doi.org/10.1016/S2666-5247(22)00259-2  PMID: 36209756 
  29. INSERM. Médecine Sorbonne Université. Réseau Sentinelles - Bilan d’activité 2022. [Sentinel network - 2022 activity report]. Paris: INSERM; 2023. French. Available from: https://www.sentiweb.fr/document/6012

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