As the smallpox epidemic in non-endemic countries continues for the second month, officials are focusing on the potential risk to groups more vulnerable to infectious diseases – such as young children and pregnant women.
Article v Ultrasound in obstetrics and gynecologypublished last week, provided some guidelines for the treatment of smallpox in pregnancy, including a recommendation that pregnant women with active smallpox should be able to give birth by caesarean section.
However, research into smallpox in pregnancy is still rare.
Smallpox, an infectious disease transmitted by monkeys, is more common in West and Central African countries.
As part of the current epidemic, the World Health Organization (WHO) documented as of June 8, 1,285 cases of monkeypox in 28 non-endemic countries, most of which had no travel links to countries where the disease is endemic.
The disease is transmitted through close contact with the infected person, and common symptoms include fever, pain, swollen lymph nodes, and a rash that turns into an elevated lesion, although the WHO notes that many cases in the current epidemic may not necessarily be monitored as traditional. medical presentation.
The risk to the general public is generally low, the organization says, and most people recover completely without treatment. No deaths have been reported in non-endemic countries, but infants and young children are at higher risk of serious illness, according to the WHO.
“The World Health Organization says that if pregnant women and children become infected, it could have adverse consequences, including congenital monkey pox, miscarriage or stillbirth, so we have provided clear guidelines for health professionals in this document,” says Dr. Edward Morris, president of the Royal College of Obstetricians and Gynecologists, said in a press release after the article was published last week.
Measures for expectant parents
The article reiterated the WHO guideline that smallpox can be transmitted to unborn babies through the placenta, leading to congenital monkey smallpox, or close contact during or after childbirth.
She cited a study of people hospitalized with the disease in the Democratic Republic of the Congo (DRC) between 2007 and 2011, including four pregnant women. Three out of four women suffered fetal loss, while a fourth gave birth to a healthy child.
Of the pregnancy losses, two women with moderate to severe miscarriage aborted in the first trimester, while a third woman developed moderate monkey chickenpox at week 18 and had intrauterine fetal death.
“It is possible that a mother infects a child; That’s 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 Academy of Obstetrics and Gynecology (ACOG) of the Committee on Emerging Infectious Diseases, helped advise Centers for Disease Control (CDC) in 2003 during an outbreak of monkeypox related to the import of Gambian rats that were housed near prairie dogs. for the animal market.
At the time, she said public health officials were concerned about pregnant women in some families who were exposed to prairie dogs and advised them to receive smallpox vaccines.
Despite caution, the risk remains low
The current US policy for pregnant women who believe they have been exposed to someone with monkey pox is to get a non-replicating JYNNEOS pox vaccine in the US; the vaccine is sold in the United Kingdom and Europe as MVA-BN.
The vaccine is considered safe for pregnant and lactating women.
The current epidemic occurs predominantly in men, with many cases involving men having sex with men, says Jamieson, stressing 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 let their doctor know. Women planning to travel during pregnancy should also look at CDC maps for details of disease risks in the countries they travel to and make sure they have the recommended vaccines.
Although ACOG did not change its caesarean section guidelines after the smallpox outbreak, public health officials are still trying to find out more about how the disease is spreading, says Jamieson.
“The new twist this time is that there seems to be a certain level of sexual transmission and a certain level of human-to-human transmission,” he says. “We want to be a little careful because we still have a lot to learn.”