CDC Data Show Mpox Risks in Cisgender, Pregnant Women

While data on mpox has mostly focused on men who have sex with men, new data from the CDC suggest that it is also important to monitor risk among cisgender women and pregnant people to examine the effects of the virus on sexual and reproductive health.

From May to November, 769 cisgender women were infected with mpox, accounting for 2.7% of all reported cases in the U.S. Of these women, 73% reported sexual activity or close intimate contact as the likely cause of exposure, and 23 cases were reported in those who were pregnant or recently pregnant, said Sascha Ellington, PhD, of the CDC Mpox Emergency Response Team, and colleagues in the Morbidity and Mortality Weekly Report.

“To date, data on mpox in cisgender women and pregnant persons have been limited,” they wrote, noting that “any person, including cisgender women, can also acquire infection.”

“Understanding transmission in these populations is critical for mpox prevention,” Ellington and team continued. “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.”

Route of delivery may be re-considered, they added, and “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).”

In addition, “adverse pregnancy outcomes, including spontaneous abortion and stillbirth, have been reported in previous mpox outbreaks,” they noted.

Of the 23 women who were pregnant or recently pregnant, 48% received tecovirimat (Tpoxx), no matter what trimester they were in, and no treatment-related adverse events were reported. Four were hospitalized, but none were admitted to the intensive care unit.

One woman reported a spontaneous abortion at 11 weeks’ gestation, and two others reported full-term deliveries without complications.

Two women reported mpox symptoms within 3 days of delivery and both of their newborns had lesions within 1 week of the mother’s symptoms. Both newborns were given tecovirimat for 10-14 days within 48 hours of lesion onset, and one was given vaccinia immune globulin intravenous. “Both newborns responded to treatment, appeared to be in good health, and were discharged home,” Ellington and colleagues noted.

Another woman who was recently pregnant and breastfeeding reported mpox lesions, including under her breast, on day 4 after giving birth. The newborn developed lesions on the face and chest nearly 1 week later.

Two other breastfeeding women reported mpox infection exposures; one was infected by her infant 2 weeks after the baby was infected by a household contact. The other woman, who was a healthcare worker, was diagnosed with mpox after caring for an asymptomatic patient. She presented with “atypical features,” the authors reported. Her breast milk was tested, and mpox was not detected.

“CDC, in collaboration with health departments, will continue to follow cases in pregnant and recently pregnant persons and provide updates as data become available,” Ellington and colleagues wrote.

Among the total 769 women, 44% were Black, 25% were white, and 23% were Hispanic.

“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,” the authors noted. “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.”

In addition to the 73% who reported exposure from a sexual or close intimate contact, 22% reported a household or caregiving exposure, 24% reported shared towels or bedding, 18% reported exposure through shared food, utensils, or dishes, and 21.7% reported sharing a bathroom with someone exposed to mpox.

Of the 296 women who reported the gender of their sexual partners in the last 3 weeks, 90% said the contact was a cisgender man, 5.5% reported it was a cisgender woman, and 0.6% said it was a transgender man.

For those who reported their symptoms, 92.6% had rash. “Rash location was similar when comparing cisgender women who reported recent sexual exposure with those who did not,” Ellington and team noted.

As of January 4, the 7-day average of mpox cases was four, down from a peak of 624 cases reported in August 2022.