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

Disclosures

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

Cases Among Cisgender Women

During May 11–November 7, 2022, a total of 769 cases of mpox among cisgender women, including 23 (3%) who were pregnant, were reported by 42 public health jurisdictions (Table 1). The median age was 32 years (IQR = 25–40 years). Among the 717 (93%) cisgender women with information on race and ethnicity, 313 (44%) were Black, 182 (25%) were White, and 167 (23%) were Hispanic. Among 463 (60%) cisgender women with information on recent sexual behaviors, 329 (71%) reported recent sexual activity or close intimate contact,*** including 296 (90%) who had recent sexual contact with a cisgender man and 18 (6%) who had recent sexual contact with a cisgender woman. Among the 18 patients who had recent sexual contact with a woman, 12 also had a recent male sex partner. Of the 73 cisgender women who had complete exposure data, 53 (73%) reported recent sexual or intimate contact as the likely route of exposure. Among the 16 who reported household contact or caregiving as the likely route of exposure, five reported recent sexual or intimate contact. Among the 378 cisgender women with available data on immunocompromising conditions, 35 (9%) reported any known immunocompromising condition other than HIV infection. Information on HIV status was available for 173 cisgender women, 13 (8%) of whom had HIV infection; no cisgender women with HIV infection were pregnant.

Among all cisgender women with mpox and available data, the most frequently reported signs and symptoms were rash (93%), headache (54%), pruritis (57%), malaise (54%), fever (49%), and chills (49%) (Table 2). Among 376 (49%) cisgender women with data on rash location, rash was most frequently reported on the legs (48%), arms (47%), genitals (36%), and trunk (33%); 50 (16%) reported rash in one region, 63 (20%) in two regions, 57 (18%) in three regions, and 140 (45%) in four or more regions. Rash location was similar when comparing cisgender women who reported recent sexual exposure with those who did not.

1 2 3 4

Next Section

Abstract and Introduction
Cases Among Cisgender Women
Cases in Currently and Recently Pregnant Persons
Discussion
References
Sidebar

***Defined as any sex or close intimate contact during the 3 weeks before symptom onset.

Table 1. Characteristics of cisgender women with mpox, by current or recent* pregnancy status — United States, May 11–November 7, 2022 ^†
Characteristic (no. with available information)	No. (%)^§ of cisgender women with mpox
Characteristic (no. with available information)	All	Not currently or recently pregnant	Currently or recently pregnant
Total (769)^¶	769 (100.0)	746 (97.0)	23 (3.0)
Gender identity (769)
Cisgender woman	769 (100.0)	746 (100.0)	23 (100.0)
Age (765)
Median, yrs (IQR)(range)	32 (25–40) (15–89)	32 (25–40) (15–89)	28.5 (23–32) (20–35)
Missing	4	4	0
Race and ethnicity (717)	717 (100.0)	696 (93.3)	21 (91.3)
American Indian or Alaska Native, non-Hispanic	4 (0.6)	4 (0.6)	0 (—)
Asian, non-Hispanic	18 (2.5)	18 (2.6)	0 (—)
Black or African American, non-Hispanic	313 (43.7)	298 (42.8)	15 (71.4)
Hispanic or Latino	167 (23.3)	165 (23.7)	2 (9.5)
Native Hawaiian or other Pacific Islander, non-Hispanic	1 (0.1)	1 (0.1)	0 (—)
White, non-Hispanic	182 (25.4)	179 (25.7)	3 (14.3)
Multiple races, non-Hispanic	10 (1.4)	10 (1.4)	0 (—)
Other race, non-Hispanic	22 (3.1)	21 (3.0)	1 (4.8)
Missing	52	50	2
Recent sexual partners (463)**	463 (100.0)	446 (60.0)	17 (73.9)
Had a recent sexual partner	329 (71.1)	317 (71.1)	12 (70.6)
Gender of recent sexual partners^††
Cisgender man	296 (90.0)	284 (89.6)	12 (100.0)
Cisgender woman	18 (5.5)	18 (5.7)	0 (—)
Transgender man	2 (0.6)	2 (0.6)	0 (—)
Transgender woman	0 (—)	0 (—)	0 (—)
Other gender identity	2 (0.6)	2 (0.6)	0 (—)
Exposure (73)^§§	73 (100.0)	61 (8.2)	12 (52.2)
Sexual or intimate	53 (72.6)	44 (72.1)	9 (75.0)
Household or caregiving	16 (21.9)	13 (21.3)	3 (25.0)
Shared food, utensils, or dishes	12 (18.2)	12 (19.7)	0 (—)
Shared towels or bedding	16 (24.2)	16 (26.2)	0 (—)
Shared transportation	10 (15.2)	10 (16.4)	0 (—)
Face-to-face	14 (21.2)	14 (23.0)	0 (—)
Shared bathrooms	15 (22.7)	15 (24.6)	0 (—)
Other	16 (24.2)	16 (26.2)	0 (—)
Health conditions
Immunocompromised (excluding HIV) (378)^¶¶	35 (9.3)	34 (9.3)***	1 (7.1)^†††
HIV infection (173)	13 (7.5)	13 (8.1)^§§§	0 (—)^¶¶¶

Abbreviation: mpox = monkeypox.
*Recently pregnant persons had confirmed or probable mpox infection within 21 days of delivery.
^†Data as of November 9, 2022.
^§Percentages calculated using nonmissing data.
^¶Information on pregnant and recently pregnant persons was gathered by the national surveillance form, clinical consultation, and enhanced pregnancy surveillance.
**Sexual partner during the 3 weeks before symptom onset.
^††Percentage of those who had a sexual partner during the 3 weeks before symptom onset.
^§§Exposures are not mutually exclusive.
^¶¶Immunocompromising conditions include diseases (e.g., diabetes, lupus, organ transplants, stem cell transplants, and cancer) or certain medicines (e.g., chemotherapy, biologic therapies, and steroids).
***Percentage among the 364 cisgender women who are not currently or recently pregnant with data available on any known immunocompromising conditions.
^†††Percentage among the 14 pregnant or recently pregnant persons with data available on any known immunocompromising conditions.
^§§§Percentage among the 161 cisgender women who are not currently or recently pregnant with data available on HIV status.
^¶¶¶Percentage among the 12 pregnant or recently pregnant persons with data available on HIV status.

Table 2. Signs and symptoms and rash sites among all cisgender women with mpox (N = 769) — United States, May 11–November 7, 2022*
Characteristic	Presence or absence of signs or symptoms, no. (%)^†			No. missing (% of total sample)
Characteristic	Present	Absent	Unknown	No. missing (% of total sample)
Sign or symptom
Rash	376 (92.6)	17 (4.2)	13 (3.2)	363 (47.2)
Headache	182 (54.3)	122 (36.4)	31 (9.3)	434 (56.4)
Malaise	176 (53.5)	115 (35.0)	38 (11.6)	440 (57.2)
Fever	165 (48.5)	139 (40.9)	36 (10.6)	429 (55.8)
Chills	162 (49.2)	135 (41.0)	32 (9.7)	440 (57.2)
Pruritis	164 (56.8)	91 (31.5)	34 (11.8)	480 (62.4)
Myalgia	142 (45.1)	142 (45.1)	31 (9.8)	454 (59.0)
Enlarged lymph nodes	137 (41.8)	153 (46.7)	38 (11.6)	441 (57.3)
Vomiting or nausea	63 (24.3)	161 (62.2)	35 (13.5)	510 (66.3)
Abdominal pain	57 (19.2)	198 (66.7)	42 (14.1)	472 (61.4)
Rectal pain	39 (12.8)	229 (74.8)	38 (12.4)	463 (60.2)
Tenesmus	22 (8.5)	199 (76.8)	38 (14.7)	510 (66.3)
Conjunctivitis	14 (5.7)	199 (80.2)	35 (14.1)	521 (67.8)
Pus or blood in stools	12 (4.6)	210 (80.5)	39 (14.9)	508 (66.1)
Rectal bleeding	11 (3.7)	246 (82.8)	40 (13.5)	472 (61.4)
Proctitis	8 (3.3)	185 (76.5)	49 (20.3)	527 (68.5)
Rash site^§
Legs	182 (48.4)	NA	NA	NA
Arms	178 (47.3)
Trunk	125 (33.2)
Genitals	137 (36.4)
Face	116 (30.9)
Palms	81 (21.5)
Head	79 (21.0)
Hand	73 (19.4)
Neck	54 (14.4)
Mouth	57 (15.2)
Perianal	53 (14.1)
Soles	44 (11.7)
Other	100 (26.6)

Abbreviation: NA = not applicable.
*Data as of November 9, 2022.
^†Percentages calculated using nonmissing data.
^§Percentages among the 376 cisgender women who reported experiencing rash.

Table 3. Characteristics of currently and recently pregnant persons* with mpox (N = 23) — United States, May 11–November 7, 2022
Characteristic	No. (%)^†
Currently pregnant	21 (91.3)
Recently pregnant	2 (8.7)
*Pregnancy trimester when Monkeypox virus* infection occurred (10)**
First	3 (30.0)
Second	4 (40.0)
Third	3 (30.0)
Missing	11
Sign or symptom^§
Fever	6 (26.1)
Rash	23 (100.0)
Genital or breast lesions	4 (17.4)
Myalgia	2 (8.7)
Pruritis	6 (26.1)
Lymphadenopathy	3 (13.0)
Disease severity
Hospitalized
Yes	4 (17.4)
No	19 (82.6)
Admitted to ICU	0 (—)
Mpox-directed therapy^¶
Tecovirimat (oral or IV)	11 (47.8)
VIGIV	0 (—)
Postexposure prophylaxis
Received JYNNEOS	0 (—)

Abbreviations: ICU = intensive care unit; IV = intravenous; mpox = monkeypox; VIGIV= vaccinia immune globulin intravenous.
*Recently pregnant persons had confirmed or probable Monkeypox virus infection within 21 days of delivery.
^†Percentages calculated among nonmissing values.
^§Signs and symptoms are not mutually exclusive.
^¶Two women who received tecovirimat also received other treatments (e.g., acyclovir or antibiotics).