Monkeypox can be transmitted to babies during and after pregnancy.  We should be vigilant, but not frightened

Monkeypox can be transmitted to babies during and after pregnancy. We should be vigilant, but not frightened

So far, 57 confirmed and probable cases of monkeypox have been reported by Australian authorities.

In July, the Australian government issued a health warning for monkeypox as a communicable disease after the World Health Organization declared it a public health emergency.

This disease has been reported at a higher rate in men who have sex with other men. But that doesn’t mean it can’t spread to anyone. In fact, in some Western countries, it has been observed in pregnant and laboring women and their newborns.

What do we know about monkeypox?

Monkey pox is a viral disease spread between animals and humans.

UK government guidelines described the first case of “monkey pox” in 1958, when it was found in monkeys used for research purposes.

It was in 1970 that it was first reported in the human population in the African country, the Democratic Republic of Congo. The disease is now endemic in some African countries including Nigeria, Liberia, Sierra Leone and the Democratic Republic of Congo.

Read more: How is monkeypox spread? An epidemiologist explains why it’s not an STI and what counts as close contact

What does this mean for pregnant women?

Fortunately, monkeypox does not spread easily. The infection is spread through close physical contact, and there is limited information so far on the impact on pregnancy, especially in high-income countries.

The virus can enter the body through broken skin, airways or mucous membranes (the moist inner lining of the cavities and some organs in the body).

The US Centers for Disease Control and Prevention advises that the virus can be passed to the baby before birth through the placenta and after the baby is born through close physical contact.

It also recommends that pregnant, postnatal and lactating women should be prioritized for medical treatment as there is a significant risk to the baby.

Australian government treatment guidelines identify pregnant and lactating women at high risk of severe disease from monkeypox infection. They also identify these groups as eligible for treatment and encourage healthcare providers to consult with infectious disease specialists.

What symptoms should you watch for?

Symptoms of monkeypox can include headache and fever, muscle and joint pain, fatigue, swollen lymph nodes, and a telltale rash with lesions that develop anywhere on the body.

The lesions change and eventually rupture, crust and heal. The number and location of lesions can vary from many throughout the body to a few that are isolated to one or two areas.

Under the microscope you can see mature, oval monkeypox virions, left, and spherical immature virions, right.
Cynthia S. Goldsmith, Russell Regner/CDC via AP

Read more: Monkey pox in Australia: should you be worried? And who can get the vaccine?

Deadly for some

The European Center for Disease Prevention and Control said that most people (who are not pregnant) have a mild illness with recovery within a few weeks, but that Nigerian cases have a death rate of about 3%. Mortality is likely to be higher in vulnerable groups such as newborns and pregnant or lactating women.

A recent article published in the medical journal The Lancet provides guidance for doctors and midwives on the treatment of monkeypox infection during pregnancy. These recommendations include increased fetal monitoring and increased surveillance of the mother in hospital isolation rooms, if necessary, depending on her symptoms.

If a woman has genital lesions at the time of delivery, she may be offered a caesarean section. A newborn baby will need careful monitoring and precautions to reduce the risk of transmission from the mother. In these cases, consultation with an infectious disease pediatrician is recommended.

The Australian government stocks a monkeypox vaccine called Jynneos, which can be considered in cases where a woman has had close physical contact with an infected person or meets other criteria. The safety profile of this drug in pregnancy is unknown, but it is believed to be safe to use after a risk-benefit analysis by a physician. Women should not seek vaccination without the presence of risk factors.

Read more: Australia secures 450,000 new monkeypox vaccines What are they and who can have them?

Known cases

Several cases of monkeypox infection have been reported in the Democratic Republic of the Congo as part of a larger study. The study did not specifically look at pregnant women, but in a study of more than 200 people with monkeypox infection, four women were found to be pregnant.

Of the four women with monkeypox infection during pregnancy, two miscarried, one gave birth to a stillborn baby, and one gave birth to a live full-term baby. All three women who suffered fetal loss experienced moderate to severe disease and lost their babies in either the first or second trimester of pregnancy.

Australian women should not be too concerned at this stage given the low rate of infection in Australia. Women are very unlikely to catch monkeypox unless they have had close contact with someone already infected with the disease or have visited countries where the disease is endemic.

There are no known cases of women infected during pregnancy in Australia, but there are cases in the UK and US.

Avoiding contact with infected people and seeking prompt medical attention if exposure is suspected is the best strategy as we watch the monkeypox situation evolve. Women can also follow advice from Australian authorities about monkeypox and talk to their midwife or obstetrician if they have any concerns.

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