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Update on Monkeypox


What is monkeypox?

David W. Kimberlin, MD, FAAP


The U​nited States is among several countries where cases of monkeypox infections have been reported. The virus causes a rash that can look like chickenpox (varicella); herpes simplex virus; allergic skin rashes; hand, foot, and mouth disease caused by enteroviruses; or molluscum.

The current monkeypox outbreak has been classified a global health emergency by the World Health Organization, with more than 18,000 cases reported in 75 countries. There have been more than 4,000 confirmed cases of monkeypox in the United States. At least two cases have been in U.S. children.

How does a person get monkeypox?

Monkeypox got its name after the disease was discovered in colonies of monkeys kept for research in the 1950s. It was first discovered in a person in 1970.

Anyone can get monkeypox. People spread monkeypox to other people primarily through direct skin to skin contact with infected body fluids or when sharing bedding, clothing or towels. It can also spread through large respiratory droplets from infected people, but is much more difficult to transmit through this route than COVID is.

A person is contagious from the time symptoms develop until after scabs from the rash fall off and the skin has completely healed.

In the current outbreak, monkeypox has spread to people through close physical contact with others. Anyone who has been in close contact, including sexual contact, with someone who has monkeypox can get the illness. Infections also can spread between people and their pets.

There have not been many infections in U.S. children and teens, and so far they have been mild. However, young people may need treatment if their symptoms are severe or if they are at risk of serious illness. Children under age 8 years, pregnant women, and some people with immune conditions or certain skin conditions may be at higher risk of severe disease.

Symptoms of monkeypox

The telltale sign of monkeypox virus is how the rash looks and how the spots change over time. When the rash first appears, it looks like flat spots. Classically, all the spots change at the same time, becoming raised bumps and then fluid-filled blisters that become pus-filled white/yellow sores. However, in the current outbreak some patients have had skin lesions that did not follow the usual pattern, appearing in differing stages of development and resolution on a single part of the body. Before the rash appears, early signs may include:

  • fever
  • swollen lymph nodes
  • headache
  • sore throat
  • cough

Anyone with symptoms of monkeypox should talk to their pediatrician or other health care provider—even if they do not think they had contact with someone who has monkeypox.

Not every child with a rash needs to be tested for monkeypox. If your pediatrician suspects monkeypox based on the appearance of rash and your child's history, they will take a skin swab and do a lab test. Most people recover in two to four weeks even without medicines that kill the virus causing monkeypox. There are also antiviral treatments.

Is there a monkeypox vaccine?

Because monkeypox is so rare, there is no need to vaccinate everyone. Vaccines are available for some people who may have been exposed to someone with monkeypox, including children and teens. The vaccine also may be given to people who work in a laboratory with the virus or provide medical care to infected patients.

Should my family worry about monkeypox?

Monkeypox sounds scary, but it is very, very unlikely that it will ever cause you any problems. It is much more difficult to transmit or acquire than COVID is. It is always good to be aware of health risks, but this is not one that should occupy much concern for you. In the rare event that an adult in your household develops monkeypox, share this information with your pedia​trician and discuss what you can do to protect your child from infection.

More information


David W. Kimberlin, MD, FAAP

​David W. Kimberlin, MD, FAAP, a pediatric infectious disease specialist at the University of Alabama at Birmingham, is the editor of the Red Book, the authoritative source for pediatric infectious diseases from American Academy of Pediatrics. ​​

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The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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