Monkeypox in a day care center was “only a matter of time,” says the expert. Next: swimming pools, sports, schools

“It was only a matter of time” before monkeypox made it into gathering places, said a specialist in pediatric infectious diseases wealthafter Illinois state officials announced on Friday that a day care worker had been diagnosed with the virus linked to smallpox.

“There is definitely a potential for monkeypox to spread” in day care centers, schools, campuses, prisons and other similar settings, said Dr. Alexandra Brugler Yonts, an infectious disease specialist at Children’s National Hospital in Washington, DC. She helped FDA review Jynneos — one of two smallpox vaccines approved for treating monkeypox, and by far the safer of the two.

“Anywhere there’s close physical skin contact — especially with people who are in various stages of undressing — there’s a risk,” she said.

All children and adults at the unidentified daycare in Champaign County, Illinois, are being evaluated and no other cases have been identified, state health officials said Friday, adding that Gov. JB Pritzker has been in touch with the White House regarding the situation .

But schools and residential communities aren’t the only places ripe for spread, Brugler Yonts said. Also on her list of places where transmission could occur: Swimming pools and water parks — “not through the water, but through bumping into someone with active lesions — especially in the summer given the heat and the tendency to minimize clothing.”

Contact sports like soccer and wrestling could also prove problematic, she added.

“Hopefully outbreaks can be contained more locally, but as people continue to travel, participate [aforementioned] Activities, and then with school starting soon…. I think this will be even more widespread. There have already been cases in almost every state in the USA.”

As of Friday, 7,510 cases had been identified in the US, most of the cases in New York, California and Florida, according to data from the US Centers for Disease Control and Prevention. Cases have been identified in every state except Wyoming and Montana.

More than 28,000 cases have been reported worldwide since January, virtually all in countries where monkeypox is not considered endemic, according to the CDC. The US now leads the world in identified cases, followed by Spain, Germany, the UK, France and Brazil. Since January, only 345 cases have been observed in African countries where the virus is considered endemic. According to the World Health Organization, 81 children were infected by the end of July.

Illinois health officials said Friday the U.S. Food and Drug Administration has approved the use of Jynneos, approved for use in adults ages 18 and older, for potentially affected children at the center “without jumping through normal hoops.” Mobile testing and vaccination services are on site, they added.

An FDA spokesman emailed Fortune on Friday that the vaccine would be approved for such children through an “individual patient application for expanded new drug access testing” that is filed for each. Applications will be processed and approved “as soon as possible if no comparable or satisfactory alternatives are available and are consulted by the treating licensed physicians, who will assess whether the benefit outweighs the anticipated benefit [sic] Risk.”

The spokesman did not want to comment further on the possibility of general approval for the use of Jynneos in children.

Because Jynneos is licensed and not just approved under an emergency authorization like the first COVID vaccines were, it can be used “off-label” — for example to children who have been exposed, Brugler Yonts said.

The researchers “will certainly want to collect data on the safety and, if possible, immunogenicity of these children and follow them closely since there is no pre-existing data on use in the pediatric population,” she said. “But Jynneos is safe and if this can prevent a larger outbreak in the pediatric population – and of course the adults who care for and live with them – that is very important.”

The decision to make the vaccine available to children is “worth the potential risk,” she added.

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