South Africa has recorded 22 cases of mpox since an outbreak of the disease started in May. Mpox is a viral infectious disease that’s spread between people through close physical contact such as direct skin-to-skin contact. All of the cases reported have been among men who have sex with men. But anyone can get the disease. 

Other population groups such as pregnant people and children are at risk of complications from mpox. Speaking at an earlier World Health Organisation webinar, public health medicine registrar at Steve Biko Academic Hospital, Dr Shanal Nair, unpacks key things to know. 

Pregnant women are at high risk of exposure 

At the moment data regarding mpox infection in pregnancy is limited. Some exposures that can be categorised into high risk. 

Generally high risk exposure includes those with intimate or close contact including direct skin-to-skin. Wearing a condom may not protect you against mpox because you will still have direct contact during sexual practices.  

Symptoms in pregnant women are very similar to those who are not pregnant. These include fever, headache, lymphadenopathy, malaise, sore throat, cough and rash.  

During pregnancy the cause of fever may be difficult to differentiate from other infections until a rash appears. 

If patients present with a rash in pregnant women we also need to look at other different rashes such as dermatosis and understand that mpox rash can also mimic other infections.

Adverse pregnancy associated with mpox include spontaneous pregnancy loss, stillbirths, and  preterm delivery.  

Mpox in infants and breastfeeding 

The benefits of skin-to-skin contact and breastfeeding for infants are well-known. However, there is a risk of neonatal transmission of mpox with close contact. 

Mpox can be transmitted to newborn babies by close contact during and after birth. It can also be transmitted to the foetus during pregnancy.  

Health experts have noticed that generally those with severe disease are infants who are less than one year of age, children with eczema and other conditions that compromise the immune system. 

The risk of severe disease is quite high in the child population with a case fatality rate that can reach up to 15%.

If a new mom presents a test positive for mpox, breastfeeding should be discontinued until the period of isolation has been completed. 

Breast milk expressed from a patient who is symptomatic should be discarded while breastfeeding is delayed. During this time infants can feed from pasteurised donor human milk or infant formula.

Some people who acquired the mpox virus and are breastfeeding may require support to initiate and maintain milk production and also avoid breast infection.

Preventing mpox transmission to newborns

Direct contact between a patient in isolation for mpox and their newborn is not advised. The mother and her newborn baby should be placed in separate rooms. 

If a patient chooses to have contact with her newborn, there are strict precautions that should be taken. There should be no direct skin contact. During contact, the newborn should be fully swaddled. After contact, clothing and blanket should be removed and replaced. The patient should wear well fitted protective hospital clothes during the visit.

Mpox treatment and prevention

Pregnant and breastfeeding people should be prioritised for medical treatment if required. 

Tecovirimat if available should be considered the first line antiviral for people who are pregnant, recently pregnant or breastfeeding. It is not known if Tecovirimat during pregnancy prevents mpox from birth.

Tecovirimat was originally developed for the treatment of smallpox. Available research shows that it is also effective to treat severe mpox and is recommended by the World Health Organisation (WHO). 

Vaccination prior to exposure or post exposure should be offered to those who are pregnant or breastfeeding. – Health-e News