Discussion
Monkeypox virus infections in cisgender women during May 11–November 7 constituted <3% of total U.S. cases. Consistent with disparities observed overall during the ongoing mpox epidemic, the proportion of Black and Hispanic women with mpox was higher than the proportion of Black and Hispanic women in the U.S. population.[6] This finding is similar to disparities among mpox cases in the United States overall and underscores the continued need for public health efforts to provide education on prevention of mpox and ensure equitable access to mpox vaccination, testing, and treatment.
Sex or close intimate contact within 3 weeks of symptom onset was reported by nearly three quarters of cisgender women with mpox, and genital lesions were frequently reported, suggesting sexual exposure as a likely primary route of transmission. Obstetrician-gynecologists and other providers should consider mpox when examining new genital, oral, or breast lesions. Patient education regarding risks for transmission of Monkeypox virus and other sexually transmitted infections should be provided.
Genital lesions in pregnant persons pose a risk for Monkeypox virus transmission to the fetus during vaginal delivery.¶¶¶ A thorough skin and mucosal (e.g., anal, vaginal, and oral) examination for mpox lesions should be performed in persons with possible mpox near the time of delivery to identify lesions of which they might be unaware. When mpox lesions, including genital lesions, are present, shared decision-making should be considered when discussing route of delivery. Because there might be an increased risk for severe disease in newborns, breastfeeding should be temporarily delayed until criteria for discontinuing isolation have been met (lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed).****
Clinicians caring for cisgender women and pregnant persons should become familiar with clinical considerations for the prevention, diagnosis, and treatment of mpox†††† and should provide pre- and postexposure prophylaxis if indicated. Vaccination with JYNNEOS should be provided to eligible persons, including those who are pregnant or breastfeeding, and providers should discuss vaccination risks and benefits.§§§§
The findings in this report are subject to at least three limitations. First, data for some variables such as exposure risk and HIV status were frequently missing (≤92%). Thus, these data might not represent the characteristics of the overall sample. Second, the small sample size of currently and recently pregnant persons with mpox might limit the generalizability of outcomes. Finally, additional time is needed for pregnancy completion to describe outcomes among all cases of mpox during pregnancy.
Cases of mpox have occurred primarily among adult gay, bisexual, and other MSM during the current outbreak; however, any person, including cisgender women, can also acquire infection. Public health efforts should include more emphasis on cisgender women who might be at increased risk for exposure. In addition, although most reported cases of mpox in pregnant persons have been managed in the outpatient setting, some persons might require hospitalization, and there is a risk for perinatal transmission. To mitigate this risk, pregnant, recently pregnant, and breastfeeding persons should be offered prophylaxis or treatment if indicated. Continued collection of information is critical to evaluating the risk for transmission, informing infection prevention and control, and assessing the impact of mpox on the sexual, reproductive, and overall health of cisgender women. In addition, collection of longitudinal data among pregnant persons and their infants is critical to understanding the effects of mpox on maternal and neonatal outcomes. CDC, in collaboration with health departments, will continue to follow cases in pregnant and recently pregnant persons and provide updates as data become available.
Acknowledgments
Mpox response teams from state and local health departments; hospital and clinical providers involved in CDC clinical consultations; Suzanne Newton, Ruth Stefanos, CDC; Thandiwe Bobb, Georgia Department of Public Health; Kay Hooshmand, Chase Israel, Claire Park, Jasmine Sharma, Los Angeles County Department of Public Health; mpox case investigation and response staff members at Acute Communicable Disease Control Program and Community Field Services Division, Los Angeles County Department of Public Health; Marcie Babcock, Victor Cruz, Minnesota Department of Health; Jennifer MacFarquhar, CDC Career Epidemiology Field Officer, North Carolina Department of Health and Human Services; Karen Alroy, Ellen Lee, New York City Department of Health and Mental Hygiene; Lisa McHugh, W. Gina Pang, Nottasorn Plipate, Kumar Nalluswami, Arlene Seid, Pennsylvania Department of Health; Lenore Asbel, Aasta Mehta, Ayomide Sokale, Philadelphia Department of Public Health; Division of Disease Control Response Team, Philadelphia Department of Public Health; Hospital Obstetrics/Gynecology and Infectious Disease Partners, Philadelphia, Pennsylvania; Public Health – Seattle & King County Communicable Disease Investigations Team; Liz Harris, Robertson Nash, Pamela Talley, Tennessee Department of Health; Nicholas Hysmith, LeBonheur Children's Hospital; Sandra Castejon-Ramirez, St. Jude Children's Research Hospital, LeBonheur Children's Hospital.
Morbidity and Mortality Weekly Report. 2023;72(1):9-14. © 2023 Centers for Disease Control and Prevention (CDC)
