Everything You Need to Know About Monkeypox During Pregnancy

Monkeypox can be very risky during pregnancy. It's important to apply certain health strategies to avoid infection. Learn more.

Written and verified by the dermatologist Maria del Carmen Hernandez.

Last update: 22 May, 2023

There’s very limited information regarding monkeypox during pregnancy. However, there are some real considerations to take into account to prevent its occurrence or complications during these nine months. Here’s everything you need to know about it. Take note!

What is monkeypox?

Monkeypox is a disease of viral origin very similar to the smallpox we’ve known for a long time. This virus causes itching, fever, swollen lymph nodes, and eruptive skin lesions that can appear in different areas.

There are two types of monkeypox virus variants:

1. The Congo Basin virus
2. The West African virus

The first time this disease was identified was in 1958, following an outbreak in the monkeys being used for research. Hence the nomenclature of “monkeypox”. In contrast, in 2022, the World Health Organization officially declared the outbreak of the disease a Public Health Emergency of International Concern.

This most recent form of smallpox is considered a zoonotic disease. That is, it can be transmitted from animals to humans and vice versa. However, it can also be transmitted between humans.

Its mode of transmission is through direct contact with the virus via blood, body fluids, respiratory droplets, or skin and mucosal lesions. According to a Centers for Disease Control and Prevention (CDC) publication, the monkeypox virus can also be transmitted through intimate contact.

The symptoms and treatment of monkeypox

The symptoms of the various types of monkeypox are very similar. However, the symptoms of monkeypox tend to be milder. In this regard, after the first contact with the virus, it takes 6 to 13 days to express initial symptoms. However, this period may vary from 5 to 21 days.

The earliest signs may include the following:

• Fever
• Low back pain
• Fatigue
• Muscle pain
• Headache
• Chills
• Swollen lymph nodes

The most affected regions

After the onset of fever, around 3 days, urticaria usually begins, affecting the following regions:

• Face
• Palms of the hands
• Plantar region
• Mouth
• Eyes, including the cornea and the conjunctiva
• Genitalia

Skin lesions associated with the monkeypox virus consist of conditions in the following order: Macules, papules, vesicles, pustules, and crusts. Eventually, after the scabs dry, they flake and shed. In general, the symptoms last about 2 to 4 weeks, while they tend to disappear without any treatment. There are no specific therapeutic options, only medication to mitigate the signs and spread of the virus.

Can women be vaccinated for monkeypox during pregnancy?

According to WHO, the vaccine is 85% effective in preventing the development of monkeypox. Therefore, those who have been inoculated for monkeypox at an early age may experience mild symptoms upon contact with the virus.

There are two vaccines available to prevent the disease: ACAM2000 and JYNNEOS. However, administration of the ACAM2000 vaccine is contraindicated, as there’s a possibility of infection and birth defects in the fetus. Women vaccinated with this variant are advised to avoid becoming pregnant for at least 4 weeks.

The JYNNEOS vaccine is the most recommended vaccine against monkeypox during pregnancy. It has proven efficacy and protection against infection. In addition, the CDC recommends frequent hand washing and avoiding direct contact with infected people or objects to prevent infection.

The risks of monkeypox during pregnancy

Some of the complications of monkeypox may include the following:

• Sepsis
• Bronchopneumonia
• Secondary infections
• Corneal infections
• Encephalitis

Corneal infection can lead to vision loss. In severe cases, the lesions can even fuse and cause the loss of important extensions of the cutaneous surface. In the few studies that exist in pregnant women, transmission may result in the following fetal clinical manifestations:

• Hydrops fetalis
• Maculopapular skin lesions
• Hepatomegaly
• Premature delivery

Applying sanitary strategies is key

Scientific evidence has suggested that there’s a high probability of vertical infection during pregnancy, which can cause serious damage to the fetus. Therefore, certain sanitary strategies, such as the use of protective equipment, social distancing, hand washing, and family planning, are essential. These can help to avoid possible infection in this group.