Pregnant people, young children, and immunocompromised individuals are at an increased risk of severe monkeypox, also known as mpox. However, there is a lack of data on the prevention and treatment of mpox in these vulnerable groups.
The available information on mpox cases among pregnant women and young children highlights the need for more detailed age distribution reporting. Additionally, at the onset of the mpox outbreak, there were no clear guidelines for managing mpox in pregnancy or childhood, and available therapeutics and vaccines were not approved for use in these groups.
The Lancet mentioned in their recent publication that women who are pregnant, children under the age of eight, and those with weakened immune systems are more prone to get severe mpox . Fifty-five pregnant and recent moms were questioned for 2022 WHO mpox global trends research. This sample includes four first-trimester moms, eleven second-trimester mothers, and nine third-trimester mothers. One lady was just six weeks postpartum, and almost one-third of the women had no idea how far along they were.
They were all 28 years old on average. Although 12 persons were brought to the hospital, no significant illnesses or fatalities happened. According to the Brazilian epidemiological bulletin for 2023, twenty-two pregnant women either had mpox or were suspected of having the virus; two of these women required hospitalization for isolation and treatment. 2 The CDC had identified 17 cases of confirmed or probable mpox in pregnant or recently pregnant women whose pregnancies were being monitored as of October 21st, 2022. Two further incidences occurred in moms who were nursing.
According to the most recent WHO data, 348 mpox (189 male and 159 female) and 117 cases of mpox in children under the age of five were observed in Brazil (59 male children and 64 female children). Because of the increasing occurrence of severe illnesses in children, publications should split their data by age range. Two cases of severe neonatal mpox were recorded; one of these newborns also had an adenovirus infection. The rash on both patients developed erythematous and pustular over time, finally spreading to their extremities.
The patients reacted favorably to tecovirimat and cidofovir 4 or intravenous immunoglobulin therapy. According to the most current CDC data, 35 children under five were infected with mpox (24 male children and 11 female children). Tecovirimat was administered to seventeen of these youngsters.
There were no recognized means for treating pregnant women or children at the start of the mpox epidemic, and none of the existing medications or vaccinations were safe for those age groups. Although tecovirimat was licensed to treat smallpox, there was no evidence of the drug’s efficacy against human mpox or the prevention of congenital or perinatal mpox in pregnant women.
Tecovirimat will be studied in several planned phase 3 randomized, placebo-controlled studies to treat mpox (table). Children, pregnant women, and nursing mothers are welcome to join in the open-label tecovirimat research STOMP for human monkeypox virus after discussing the risks and benefits.
A phase 3 clinical trial involving several locations in Canada (PLATINUM-CAN) and the United Kingdom is the Placebo-Controlled Randomized Trial of Tecovirimat in Non-Hospitalized Mpox Patients (PLATINUM). However, undergraduates under 21 are not admitted to the Canadian site. The PLATINUM-CAN protocol and the UK arm of the research make no provision for pregnant or nursing women. The UNITY study (Assessing the Efficacy and Safety of Tecovirimat in Patients with Monkeypox Virus Disease) contains no mention of pregnant or breastfeeding women.
Pregnant women and young children, previously thought to be at increased risk of severe mpox, have been shown to have a low risk of severe illness during the current worldwide mpox clade IIb pandemic. On the other hand, clinical guidance and public health policies on prevention, hazards, management, and results necessitate a systematic approach to data gathering.
We highly endorse the scheduling of the PLATINUM and UNITY studies, as well as the continuing mpox vaccination trials (table), and we appreciate the STOMP trial’s horizontal enrolment criteria, which specify pregnant and nursing people’s participation, as well as the PALM partnership’s phase 2 tecovirimat arm.
There has never been a better time to learn about the safety and efficacy of immunizations and treatments for mpox illness among pregnant and nursing women, infants under one year, and children, particularly those under the age of eight. With the increasing number of mpox cases, particularly among pregnant women and young children, there is an urgent need for improved data on the prevention and treatment of this disease in these vulnerable populations.
The ongoing phase 3 trials of tecovirimat for the treatment of mpox are promising. Still, it is essential to ensure that pregnant and breastfeeding women, as well as young children, are included in the trials and that safety and efficacy data are collected for these groups. This information will be essential for developing evidence-based guidelines for managing mpox in pregnancy and childhood.