Viruela símica, viruela del simio

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 (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Cidofovir (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)
• Tecovirimat (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)