During the 2022 Multinational Monkeypox Response, cases of Monkeypox illness reported in children and adolescents in the US were rare. Early in the response, little was known about MCM safety and efficacy for treating monkeypox in children and adolescents. As cases in children and adolescents increased, knowledge about safety and efficacy evolved.

Cases of monkeypox in children <18 years of age across the US were reported to CDC. MCM consultations from clinical and regulatory affairs subject matter experts supported clinician administration and management of antiviral and immunoglobulin treatment. Data from the first pediatric cases were collected to help answer some of these questions on the use of MCM in pediatric populations.

Across the US, 116 cases of monkeypox in children <18 years of age have been verified through October 2022. Of these cases, 41 occurred in patients twelve years of age or less, with 75 cases in adolescents 13-17 years of age. Ten percent of patients were hospitalized, none required ICU care and no deaths occurred. Children were most commonly hospitalized due to young age, rash near or including the eye, secondary bacterial infections, or pain management. At least eleven patients with confirmed orthopoxvirus were treated with tecovirimat and two with Vaccinia Immune Globulin. Those who received MCM recovered and tolerated treatments well with one patient stopping treatment secondary to development of a drug rash.

Data on the safety and efficacy of MCM for monkeypox are limited in pediatric populations. As of November 3, 2022, most cases of monkeypox in the pediatric population in the 2022 monkeypox outbreak were mild and self-limited. Patients who received MCM recovered and tolerated treatments without serious adverse events. These findings can inform clinicians and public health providers about the clinical features of monkeypox in children and provide information about MCM treatment options.