• communicable diseases
• infectious disease medicine
• virology
• epidemiology
• paediatrics

On 23 July 2022, the WHO declared the current global monkeypox outbreak to be a Public Health Emergency of International Concern, its highest level of alert. Monkeypox is endemic in central and western Africa, where most cases and deaths due to monkeypox disease have been reported since the first human cases were identified more than 50 years ago. In non-endemic countries, monkeypox cases and outbreaks have, until recently, involved persons travelling from endemic countries, occasionally with subsequent person-to-person spread. These have been contained rapidly with early diagnosis, contact tracing and isolation of cases and their close contacts. The current global outbreak, however, lacks epidemiological links to endemic countries. As of 22 July 2022, more than 16 000 people were diagnosed with monkeypox disease across 74 countries,1 predominantly affecting men who identify as gay, bisexual or other men who have sex with men.2 There is still little evidence that the outbreak has moved outside this high-risk network. In the UK, of 2218 cases confirmed by 21 July 2022, only 15 were women.3 So far, only one child is known to have developed monkeypox disease in the UK and 72 cases in children and young people (CYP) under 18 years of age globally. While reassuring, the increase in adult cases will inevitably lead to children being exposed in household, school or other similar settings. Some may also be exposed through sexual contact, while newborns may be exposed antenatally or perinatally.

The UK Health Security Agency (UKHSA) regularly updates national guidance on public health management of monkeypox. Early in the current outbreak, the Royal College of Paediatrics and Child Health (RCPCH) formed a Monkeypox Working Group to adapt the guidance to CYP. This multidisciplinary group includes paediatric infectious diseases specialists working within the High Consequence Infectious Diseases (HCID) network and UKHSA …