As the monkeypox outbreak continues its second month in non-endemic countries, officials are focusing on the potential risk to groups most vulnerable to infectious diseases, such as young children and pregnant women.
An article in Ultrasound in Obstetrics and GynecologyPublished last week, it provided some guidelines on the management of monkeypox in pregnancy, including recommendations that pregnant women with active monkeypox should be given the option to give birth by caesarean section.
However, research on pregnant monkeypox is still sparse.
Monkeypox, an infectious disease transmitted by monkeys, is more common in West and Central African countries.
As part of the current outbreak, the World Health Organization (WHO) documented 1,285 cases of monkeypox in 28 non-endemic countries on 8 June, 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 infants and young children are at increased risk of serious illness, according to WHO.
“The World Health Organization says there may be adverse outcomes for pregnant women and children if they become infected, including congenital monkeypox, miscarriage or stillbirth, which is why we have provided clear guidance for healthcare professionals in this document. “said Dr. Edward Morris, president of the Royal College of Obstetricians and Gynecologists, said in a press release after the article was published last week.
Precautions for future parents
The article reiterated WHO guidelines that monkeypox can be transmitted to unborn babies through the placenta, resulting in monkeypox congenital or through close contact during or after birth.
He cited a study of people hospitalized with the disease in the Democratic Republic of 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 suffered 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 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 an import-related monkeypox outbreak. of Gambian rats that were housed were close to the prairie dogs destined for the pet market.
At the time, he said public health officials were concerned about pregnant women in some of the families who had been exposed to prairie dogs and recommended vaccinating against smallpox.
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 JYNNEOS non-replicating smallpox vaccine in the US; the vaccine is marketed in the UK and Europe as MVA-BN.
The vaccine is considered safe for pregnant and lactating women.
The current outbreak is predominantly in men, with a number of cases linked to men having had sex with men, Jamieson says, noting 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 tell their doctor. Women planning to travel during pregnancy should also look at CDC maps that detail the disease risks in the countries they travel to and make sure they have the recommended vaccines.
Although ACOG hasn’t changed its caesarean guidance in the wake of the monkeypox outbreak, public health officials are still trying to find out more about how the disease spreads, says Jamieson.
“The new twist this time around is that there appears to be a certain level of sexual transmission and a certain level of person-to-person transmission,” he says. “We want to be a little careful because we still have a lot to learn.”