Mpox Cases Among Cisgender Women and Pregnant Persons — United States, May 11–November 7, 2022

United States, May 11-November 7, 2022

Lisa P. Oakley, PhD; Kaitlin Hufstetler, MD; Jesse O'Shea, MD; J. Danielle Sharpe, PhD; Cristin McArdle, PhD; Varsha Neelam, MPH; Nicole M. Roth, MPH; Emily O. Olsen, PhD; Maren Wolf, MPH; Leah Zilversmit Pao, PhD; Jeremy A. W. Gold, MD; K. Meryl Davis, MD; Dana Perella, MPH; Shara Epstein, MD; Maura K. Lash, MPH; Olivia Samson, MPH; Jessica Pavlick, DrPH; Amanda Feldpausch, DVM; Jennifer Wallace, MD; Atmaram Nambiar, MD; Van Ngo, MPH; Umme-Aiman Halai, MD; Claudia W. Richardson, MD; Traci Fowler, DNP; Burnestine P. Taylor, MD; Joyce Chou, MSPH; Lindsey Brandon, MSN; Rose Devasia, MD; Erin K. Ricketts, MD; Catherine Stockdale; Mellisa Roskosky, PhD; Rachel Ostadkar; Yeng Vang; Romeo R. Galang, MD; Kiran Perkins, MD; Melanie Taylor, MD; Mary Joung Choi, MD; Paul J. Weidle, PharmD; Patrick Dawson, PhD; Sascha Ellington, PhD


Morbidity and Mortality Weekly Report. 2023;72(1):9-14. 

In This Article

Abstract and Introduction


Monkeypox (mpox) cases in the 2022 outbreak have primarily occurred among adult gay, bisexual, and other men who have sex with men (MSM); however, other populations have also been affected.[1] To date, data on mpox in cisgender women and pregnant persons have been limited. Understanding transmission in these populations is critical for mpox prevention. In addition, among pregnant persons, Monkeypox virus can be transmitted to the fetus during pregnancy or to the neonate through close contact during or after birth.[2–5] Adverse pregnancy outcomes, including spontaneous abortion and stillbirth, have been reported in previous mpox outbreaks.[3] During May 11–November 7, 2022, CDC and U.S. jurisdictional health departments identified mpox in 769 cisgender women aged ≥15 years, representing 2.7% of all reported mpox cases. Among cases with available data, 44% occurred in cisgender women who were non-Hispanic Black or African American (Black), 25% who were non-Hispanic White (White), and 23% who were Hispanic or Latino (Hispanic). Among cisgender women with available data, 73% reported sexual activity or close intimate contact as the likely route of exposure, with mpox lesions most frequently reported on the legs, arms, and genitals. Twenty-three mpox cases were reported in persons who were pregnant or recently pregnant§; all identified as cisgender women based on the mpox case report form. Four pregnant persons required hospitalization for mpox. Eleven pregnant persons received tecovirimat, and no adverse reactions were reported. Continued studies on mpox transmission risks in populations less commonly affected during the outbreak, including cisgender women and pregnant persons, are important to assess and understand the impact of mpox on sexual, reproductive, and overall health.

Data on confirmed and probable cases of mpox are electronically reported as part of national case surveillance through a standardized case report form or the National Notifiable Diseases Surveillance System.** Data are collected by health departments and include demographic characteristics, possible exposure routes, and signs and symptoms. CDC analyzed case report data for probable or confirmed†† cases among cisgender women aged ≥15 years and pregnant persons during May 11–November 7, 2022. In addition, CDC identified all persons with mpox reported to CDC through national case surveillance and clinical consultations who were pregnant or recently pregnant regardless of gender identity. Detailed data regarding maternal and neonatal outcomes were obtained through enhanced pregnancy surveillance.§§ Statistical analyses were conducted using SAS statistical software (version 9.4; SAS Institute) and restricted to cases with available data. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.¶¶

*These authors contributed equally to this report. (Accessed November 7, 2022).
§Recently pregnant persons had confirmed or probable Monkeypox virus infection within 21 days of delivery.
§§Enhanced pregnancy surveillance data were collected through direct communication with jurisdictions, under an Assurance of Confidentiality, leveraging existing mother-baby linked surveillance.
¶¶45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.