Newborn Exposed to the Monkeypox Virus: A Brief Report.

Abstract

To the Editors: The increase in the number of cases of monkeypox in nonendemic areas has led the World Health Organization to declare monkeypox a global health emergency. In this report, a 37-week and 3-day pregnant woman presented with papular lesions, evolving into a pustule. She had visible adenomegaly in the submental region. Samples were collected for polymerase chain reaction (PCR) for the monkeypox virus (Table 1) and it was detected only from scrapings from a skin lesion. TABLE 1. - Polymerase Chain Reaction Results of the Mother and Newborn for Monkeypox Virus Date Sample material Methods Result Samples of the mother 04/08/22 Scraping of the lesion Real-time PCR Detectable 04/08/22 Lesion exudate Real-time PCR Not detectable 04/08/22 Serum Real-time PCR Not detectable 16/08/22 Breast milk Real-time PCR Not detectable Samples of the newborn 14/08/22 Oropharyngeal secretion Real-time PCR Not detectable 17/08/22 20/08/22 25/08/22 28/08/22 31/08/22 03/09/22 PCR indicates polymerase chain reaction. The patient developed a total of 15 lesions during the disease course. Nine days after, she was admitted to the maternity hospital because of spontaneous rupture of the amniotic membranes for 24 hours and uterine contractions at a gestational age of 39 weeks. The hospital infection control isolates the patient observing all precautions related to contact, droplets and aerosols, and recommended sample collection for PCR in the newborn after birth. On physical examination at the maternity ward, the patient had 5 lesions and a lymph node in the submental region of approximately 1.5 cm and another one in the right cervical region of approximately 1 cm, both elastic, mobile and painless. The newborn was born vaginally asymptomatic, without skin or mucosal lesions. There was no skin-to-skin contact with the mother. The newborn was admitted at the intermediate care neonatal unit. Breastfeeding was contraindicated. The mother was discharged around 40 h postpartum in good condition but still with active lesions. A sample of breast milk was collected for analysis. The PCR for the monkeypox virus was not detectable. The newborn was kept in the hospital because of active maternal lesions and for clinical follow-up. On postpartum day 8, the mother reported resolution of the lesions, confirmed by the primary care physician, and breastfeeding was established. The newborn remained asymptomatic during the follow-up evaluation. Oropharyngeal swab samples were collected to perform PCR for the monkeypox virus every 3 days until 21 days old (Table 1). Whether gestational age or disease presentation are determinants of the manifestation of the disease in the fetus remains debatable. Mbala et al.1 reported 4 cases: 2 miscarriages; 1 stillbirth 21 days after the mother’s disease onset; and 1 case with a live fetus. In another case report of coinfection of monkeypox virus and adenovirus, Ramnarayan et al.2 did not rule out transplacental infection, because the mother had a skin rash on a postpartum day. The current literature recommends that postpartum women with active monkeypox lesions should avoid close contact with the newborn, considering the risk of transmission and the potential for severe disease.3–5 It is unknown whether the monkeypox virus can be transmitted through breast milk.3,4 In the present case, all samples tested negative for the monkeypox virus and the newborn remained asymptomatic after 21 days, which suggested he did not acquire the infection from his mother. The consequences of monkeypox during pregnancy or the occurrence of its transmission through breastfeeding remains unknown. Therefore, reported cases that occurred in this population are important in view of the current advancing outbreak to define guidelines for appropriate management.4