Mpox transmission in children is influenced by multiple factors operating at the individual, community, and societal levels, as well as through interactions with intermediate hosts (Fig. 1). These interconnected dynamics provide a comprehensive understanding of how the virus spreads in pediatric populations, particularly in historically endemic regions where children are susceptible.

Factors determining monkeypox transmission in children in an adapted socioecological model

Younger children often engage in frequent physical contact with caregivers, peers, and family members, increasing their likelihood of exposure to Mpox [5]. Limited adherence to hygiene practices and the inability to practice effective social distancing further exacerbate their susceptibility. Additionally, children’s weaker immune systems, often compounded by coinfections such as varicella-zoster virus, increase their risk of acquiring infection and experiencing severe complications [6].

Limited access to clean water and adequate sanitation, especially in resource-limited settings, creates fertile ground for the spread of the virus [7, 8]. Schools and daycare centers, where large numbers of children gather, are significant hotspots for transmission. For example, in the DRC, the reopening of schools corresponded with a notable increase in Mpox cases among children [9]. Crowded living conditions, such as those in urban slums or refugee camps, further increase the risk of exposure by increasing contact with infected individuals or contaminated objects [7].

The limited healthcare infrastructure in impoverished regions delays diagnosis and hinders effective containment and treatment. Public health measures, such as vaccination campaigns, remain insufficient in many areas, leaving children particularly vulnerable to the virus. A lack of awareness, stigma around the disease and inadequate health education further compound these challenges, making it difficult to implement prevention strategies effectively [8, 10, 11].

Animal reservoirs such as rodents contribute significantly to Mpox transmission. Children living in rural areas who interact with these animals are postulated to be at increased risk of zoonotic transmission [12].