As the monkeypox outbreak continues its second month in non-endemic countries, officials are focusing on the potential risk for groups more vulnerable to the infectious diseases — such as young children and pregnant women.
An article in Ultrasound in Obstetrics & Gynecologypublished last week, provided some guidance on managing monkeypox in pregnancy, including recommendations that pregnant women with active monkeypox should be given the option to deliver by cesarean section.
However, research into monkeypox in pregnancy is still sparse.
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Monkeypox, an infectious disease transmitted by monkeys, is more common in West and Central African countries.
As part of the current outbreak, as of June 8, the World Health Organization (WHO) has documented 1,285 cases of monkeypox in 28 non-endemic countries, most of which had no travel links to countries where the disease is endemic.
The disease is transmitted through close contact with an infected person and common symptoms include fever, pain, swollen lymph nodes and a rash that turns into raised lesions, although the WHO notes that a number of cases in the current outbreak are not necessarily traditional followed are medical presentation.
The risk to the general public is generally low, the organization says, and most people make a full recovery without treatment. No deaths have been reported in non-endemic countries, but babies and young children are at higher risk of serious illnesses, according to the WHO.
“The World Health Organization states that there might be adverse outcomes for pregnant women and babies if they become infected, including congenital monkeypox, miscarriage or stillbirth, which is why we have provided clear guidance for healthcare professionals in this document,” Dr. Edward Morris, President of the Royal College of Obstetricians and Gynecologists, said in a press release following the article was published last week.
Precautions for expectant parents
The article reiterated the WHO guideline that monkeypox can be transmitted to unborn babies via the placenta, resulting in congenital monkeypox, or through close contact during or following birth.
It cited a study of people hospitalized with the disease in the Democratic Republic of the Congo (DRC) between 2007 and 2011, including four pregnant women. Three of the four women suffered fetal loss while the fourth gave birth to a healthy baby.
Of the pregnancy losses, two women with moderate to severe disease suffered a miscarriage in the first trimester, while the third woman developed moderate monkeypox at 18 weeks and experienced the intrauterine death of her fetus.
“It is possible for a mother to infect the baby; That’s the bad news,” says Dr. Denise Jamieson, James Robert McCord Professor and Chair of the Department of Obstetrics and Gynecology at Emory University School of Medicine in Atlanta, in an interview news week.
“The good news is that it’s still relatively rare.”
Jamieson, who is also a member of the American College of Obstetrics and Gynecology (ACOG) Committee on Emerging Infectious Diseases, helped advise the Centers for Disease Control (CDC) in 2003 during a monkeypox outbreak related to the importation of Gambian rats that were being housed were close to prairie dogs intended for the pet market.
At the time, she said public health officials were concerned regarding pregnant women in some of the families who had been exposed to the prairie dogs and recommended they get smallpox vaccines.
Despite caution, the risk remains low
The current US policy for pregnant women who believe they have been exposed to someone with monkeypox is to receive the non-replicating smallpox vaccine JYNNEOS in the US; the vaccine is marketed in the UK and Europe as MVA-BN.
The vaccine is considered safe for pregnant and breastfeeding women.
The current outbreak is predominantly in men, with a number of cases being linked to men who have had sex with men, Jamieson says, stressing that the risks to pregnant women are small.
At the same time, she said, pregnant women who notice a rash or new genital lesions should let their doctor know. Women planning to travel while pregnant should also look at CDC maps detailing disease risks in the countries they are traveling to and make sure they have recommended vaccines.
Although ACOG hasn’t changed its guidance on caesareans in the wake of the monkeypox outbreak, public health officials are still trying to find out more regarding how the disease spreads, Jamieson says.
“The new twist this time around is that there seems to be some level of sexual transmission and some level of person-to-person transmission,” she says. “We want to be a little careful because we still have a lot to learn.”