Monkeypox cases are on the rise across America and around the world, with the U.S. Centers for Disease Control and Prevention reporting more than 15,000 confirmed states cases as of August 23. The Biden administration is accelerating vaccine distribution and expanding community outreach, including through community partnerships and training of clinicians and patients.
Meanwhile, the students go back to school. Parents, carers, teachers and students have many questions. Can monkeypox be spread by sitting next to someone with the virus in a classroom or playing together on the playground? Can it be transmitted by sharing food or drink? Are there certain activities for K-12 students at higher risk? What about students? And what about the risk of other infectious diseases?
To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and mother of two young children who will both start school next week.
CNN: Can you remind us how monkeypox spreads and who is at high risk?
dr. Leana Wen: Monkeypox is mainly spread through prolonged, direct, skin-to-skin contact with someone who is actively shedding virus. It is associated with intimate sexual activity, but can be spread through other close contact, such as kissing and hugging. The earliest affected groups are gay, bisexual and other men who have sex with men. A recent study published by the CDC found that 99% of cases were in men, with 94% reporting recent male-to-male sexual or close intimate contact.
This contrasts with another disease we’ve talked about a lot over the past two years, Covid-19. Covid-19 is caused by an airborne virus that is highly contagious. You can get Covid-19 by talking to someone or just 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 who is infected – but that is a much less common means of transmission than direct contact.
CNN: Let’s talk about some examples of common scenarios in school settings. Can monkeypox be spread by sitting next to someone in a classroom or riding a bus together?
female: That is extremely unlikely. Monkeypox is not transmitted by just sitting next to a person. Again, this is not Covid-19 – this virus is not nearly as contagious.
CNN: What about kids playing together on the playground? Would touching the same objects put them at risk for monkey pox transmission?
female: In theory, it is possible that a child with a rash can touch another child while playing together. Small children also put objects in their mouths that can be touched by other children, and so transmission can take place.
I’m not worried about my two young children, ages 2 and 5, getting monkey pox because it hasn’t spread to children in the United States so far. There are a few isolated reports of children having monkey pox, but no reports of children passing it on to each other. The incidence of monkey pox among children is currently so low that I am not concerned about spreading it while my children are in preschool and kindergarten.
This could change if outbreaks occur in children, but that’s not what we’ve seen so far.
CNN: Can monkeypox be spread by sharing drinks or food?
female: Yes. Again, this is a lower risk than the other close activities discussed earlier, such as sexual activity, but sharing drinks or food is a possible transmission method. People infected with monkey pox should not share utensils or food or drink with others.
CNN: You mentioned earlier that it can be spread through bedding and towels. Should parents and guardians be concerned about fitting their children and avoid traveling in hotels?
female: I do not think so. If someone is infected with monkey pox, they can transfer the virus to their clothing and other things that affect their rash, such as sheets, towels, and other linens. If anyone in your family has monkey pox, no one should share their clothes or bed.
But that’s very different from going so far as not to try on clothes at the mall or staying in hotels. Of course, there’s a theoretical possibility that the person who just tried the same clothes had monkey pox and left virus on the clothes, but the chances of that happening are very slim. The same goes for hotels, where sheets and towels still need to be changed between guests.
CNN: Are there any higher-risk activities for K-12 students?
female: Activities that involve prolonged skin-to-skin contact are at greater risk. For example, children who wrestle or tackle football are at greater risk than if they were cross-country skiing or swimming.
That does not mean that children should not participate in contact sports. Again, the incidence of monkey pox in children is currently so low that this should not be a major concern.
Some students at school are sexually active. My concern would be for those students, especially those with multiple partners or who have sexual encounters with people they don’t know well, because it is through such intimate activities that monkey pox mainly spreads.
CNN: Which brings me to students. What are risky activities for them and what precautions should they take?
female: Let’s look at the activities by risk level. The greatest risk is sexual intercourse with multiple partners. Intimate activities such as kissing and cuddling with several people are also said to carry a high risk.
Sharing drinks, food and items such as cigarettes and vaping can also lead to monkey pox transmission, although that risk is lower. Monkeypox transmission has also been documented in individuals dancing in close circles with many other people for long periods of time, especially if most people don’t wear clothing over parts of their bodies – resulting in more skin-to-skin contact.
Being platonic roommates with someone is a lower risk, as is participating in most sports. Other daily activities, such as going to class, dining with peers, and socializing with friends are extremely low risk. Teaching staff, professors and other school and university personnel are at extremely low risk if they do not have direct skin-to-skin contact with students or each other.
CNN: What precautions would you advise students to take?
female: Know the highest risk activities and try to reduce your risk. Since sexual activity is the greatest risk, consider reducing the number of sex partners until you are vaccinated. Before engaging in intimate activities, ask if the other person has had any new or unexpected rashes — and, if possible, consider exchanging contact information with new sexual partners in case you or they develop symptoms later on. Try not to share drinks, food or cigarettes with several unknown people. If you go to nightclubs or bars where you expect to be very close to a lot of people, consider wearing long sleeves and pants to cover the areas that others will get close to.
I would also urge everyone to know the signs and symptoms to watch out for. In most cases, monkeypox presents as a fever, swelling of the lymph nodes and a skin rash that then results in blistering. However, fever and swelling of the lymph nodes are not always present. You may also only have one or two small rashes anywhere on your body. Monkeypox can also present as sores in your mouth, on your genitals, or in your anus. If you have any of these symptoms, get tested.
This reminds me: students need to know where to go for testing. Many colleges offer on-site testing. Others will suggest you go to a nearby commercial lab. Colleges should all have isolation procedures. It would help to know what they are ahead of time so that you are not caught off guard if your test is positive.
Finally, those students who are eligible to get vaccinated should do so as well. 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 obtain them depends on the part of the country. My strong advice to people who meet the CDC’s eligibility suggestions is to get the vaccine if you can — that lowers your chances of getting infected and also of passing monkeypox on to others.
CNN: Big Picture – How should parents, caregivers, teachers and students view the risk of monkeypox along with the risk of other infectious diseases?
female: This differs per age group. For anyone who has not yet engaged in sexual activity, the risk is very low, given the populations affected by monkeypox to date. The communal living environment in college, combined with higher-risk activities, makes monkeypox a much greater concern for students in that age group.