Last update Sept. 21, 2023

Mpox, maternal infection with monkeypox virus

High Risk

Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.

Monkeypox is an infectious disease caused by a zoonotic orthopoxvirus, the Mpox virus, of the same family as smallpox virus. It has a similar presentation to smallpox, but is much less severe and with low mortality. It presents with fever, pain, fatigue, lymphadenopathy and the appearance after 24-72 hours of multiple vesicles predominantly on the face, hands and feet. In childhood, symptoms may be more severe and mortality is higher. (Killikelly 2022, WHO/WHO 2022, CDC 2022, RCPCH 2022, Khalil 2022)

It is transmitted from animals (rodents) to humans (Jamieson 2005) and between humans by direct contact (skin, respiratory, saliva, fomites, and sexual lesions) and through the placenta. It is not known whether the virus is excreted in breast milk. The disease is contagious as long as there are symptoms (two to four weeks). (Alonso 2023, WHO/WHO 2022)

Given the mode of transmission (saliva, respiration, skin), if the mother is infected and the infant is not, it is advisable to isolate the infant and not breastfeed (AAP 2023, Gaeta 2022, RCPCH 2022, Khalil 2022, RCOG 2022), although pasteurized breast milk can be given to newborns. (Yan 2023)

The socio-economic and health situation should be taken into account in deciding to isolate mother and infant and not to breastfeed, as, in low- and middle-income countries, the benefits of breastfeeding may outweigh the risk of neonatal monkeypox infection. (Khalil 2022)

If mother and infant are infected (which should be frequent, as typical skin lesions appear after fever), it should be assessed whether they should remain together and breastfeeding should be maintained (RCPCH 2022), which could provide defenses to the infant. All this depends on the clinical condition of mother and infant. 

The existing smallpox vaccines are live attenuated viruses and are contraindicated in children under one year of age, pregnant women and immunocompromised persons or those with atopic dermatitis (Rizk 2022). Imvamune®, a new third-generation non-replicating smallpox vaccine, can be offered to immunocompromised, pregnant, breastfeeding, under 18 years of age and/or with atopic dermatitis (Killikelly 2022), as well as other non-replicating vaccines. (Daneji 2022)

Tecovirimat or Brincidofovir antivirals and human anti-vaccinia gamma globulin are indicated in severe cases (Rizk 2022, CDC 2022), and in these cases administration of tecovirimat during lactation should be considered. (CDC 2023)


See below the information of these related products:

  • Brincidofovir (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)
  • Cidofovir ( Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.)
  • Tecovirimat (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Group

Mpox, maternal infection with monkeypox virus belongs to this group or family:

References

  1. CDC Centers for Diseases Control. Guidance for Tecovirimat Use. Clinical guidance. 2023 Consulted on July 17, 2023 Full text (link to original source)
  2. None Monkeypox/Smallpox Vaccine (ACAM2000®). 2022 Nov. Mother To Baby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. Consulted on July 17, 2023 Abstract Full text (link to original source)
  3. None Monkeypox/Smallpox Vaccine (JYNNEOS™). 2022 Nov. Mother To Baby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. Consulted on July 17, 2023 Abstract Full text (link to original source)
  4. None Mpox (Monkeypox). 2022 Nov. Mother To Baby | Fact Sheets [Internet]. Brentwood (TN): Organization of Teratology Information Specialists (OTIS); 1994-. Consulted on July 17, 2023 Abstract Full text (link to original source)
  5. Khalil A, Samara A, O'Brien P, Morris E, Draycott T, Lees C, Ladhani S. Monkeypox and pregnancy: what do obstetricians need to know? Ultrasound Obstet Gynecol. 2022 Jul;60(1):22-27. Consulted on July 17, 2022 Abstract Full text (link to original source)
  6. RCPCH. Royal College of Pediatrics and Child Health. Monkeypox outbreak 2022 - guidance. Resources. 2022 Consulted on July 16, 2022 Full text (link to original source) Full text (in our servers)
  7. WHO. Monkeypox. Health Topics. 2022 Consulted on July 13, 2022 Full text (link to original source) Full text (in our servers)
  8. Rizk JG, Lippi G, Henry BM, Forthal DN, Rizk Y. Prevention and Treatment of Monkeypox. Drugs. 2022 Jun 28. Consulted on July 13, 2022 Abstract Full text (link to original source)
  9. Mother to Baby. Viruela del Mono. Hoja informativa. 2022 Consulted on July 13, 2022 Full text (link to original source) Full text (in our servers)
  10. OMS. Viruela símica. Temas de Salud. 2022 Consulted on July 13, 2022 Full text (link to original source) Full text (in our servers)
  11. RCOG. Royal College of Obstetricians & Gynaecologists. New paper provides best practice for managing monkeypox in pregnancy. News. 2022 Consulted on June 17, 2022 Full text (link to original source)
  12. Yan K, Tang LK, Xiao FF, Zhang P, Lu CM, Hu LY, Wang LS, Cheng GQ, Zhou WH. Monkeypox and the perinatal period: what does maternal-fetal medicine need to know? World J Pediatr. 2023 Mar;19(3):213-223. Abstract Full text (link to original source)
  13. Alonso-Cadenas JA, Andina-Martínez D, García-García CJ, Gaitero-Tristán J, García-Ascaso MT, Torrelo A. Monkeypox disease in a breastfeeding infant. Pediatr Dermatol. 2023 Jan;40(1):214-215. Abstract
  14. Gaeta F, De Caro F, Franci G, Pagliano P, Vajro P, Mandato C. Monkeypox Infection 2022: An Updated Narrative Review Focusing on the Neonatal and Pediatric Population. Children (Basel). 2022 Nov 26;9(12). pii: 1832. Abstract Full text (link to original source)
  15. Daneji SM, Aminu A, Borodo AM, Dayyab FM. Monkeypox in human pregnancy: an overview. AJOG Glob Rep. 2022 Nov;2(4):100130. Abstract Full text (link to original source)
  16. AAP Monkeypox. Patient care. 2022 Full text (link to original source)
  17. Killikelly A, Brousseau N. Summary of the National Advisory Committee on Immunization (NACI) Rapid Response-Interim guidance on the use of Imvamune in the context of monkeypox outbreaks in Canada. Can Commun Dis Rep. 2022 Jul 7;48(7-8):367-371. Abstract Full text (link to original source)
  18. Jamieson DJ, Jernigan DB, Ellis JE, Treadwell TA. Emerging infections and pregnancy: West Nile virus, monkeypox, severe acute respiratory syndrome, and bioterrorism. Clin Perinatol. 2005 Sep;32(3):765-76. Review. Abstract Full text (link to original source)

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