Mpox in Cisgender Women and Pregnant People, U.S., May–November 2022

The 2022 mpox outbreak mainly affected gay, bisexual and other men who have sex with men, but not only them. CDC and health departments looked at cases among cisgender women aged 15 and older and among pregnant people reported from May 11 to November 7, 2022 — groups where little was known, and where the virus can pass to a fetus or newborn.

Cisgender women

769 cases were reported by 42 jurisdictions — 2.7% of all U.S. mpox cases. The median age was 32.

• Disparities: Black and Hispanic women made up a larger share of cases than of the U.S. female population, as in the outbreak overall.
• Symptoms: rash (93%), itching (57%), headache (54%), malaise (54%), fever (49%) and chills (49%).
• Rash sites: legs (48%), arms (47%), genitals (36%) and trunk (33%); nearly half had rash in four or more body regions. The pattern was similar whether or not exposure was sexual.

Pregnant and recently pregnant people

23 cases: 21 during pregnancy and 2 within three weeks after. All identified as cisgender women.

• Exposure: of 12 with data, 9 reported sexual contact and 3 household contact.
• Timing: of 10 with data, 3 in the first trimester, 4 in the second, 3 in the third.
• Illness: everyone had a rash; 4 had genital lesions, none near delivery. 4 were hospitalized — for pain control and bacterial skin infection — and were still pregnant at discharge. None needed intensive care, intubation or an unplanned delivery.
• Treatment: 11 (48%) received tecovirimat, in every trimester, with no adverse reactions.

Outcomes so far

• Of the 21 diagnosed during pregnancy, 3 had outcomes: two full-term births without complications or infection of the baby, and one miscarriage at 11 weeks.
• Two people developed symptoms within 3 days after delivery; their newborns developed lesions within a week. Both babies received oral tecovirimat within 48 hours (one also received vaccinia immune globulin), responded, and went home healthy.
• One breastfeeding mother developed lesions, including under the breast, 4 days after birth; her newborn developed lesions on the face and chest 6 days later.
• A breastfeeding woman infected through work had breast milk tested: negative for the virus.

What clinicians should do

• Consider mpox for new genital, oral or breast lesions, and counsel patients on mpox and other sexually transmitted infections.
• Near delivery, examine skin and mucosa carefully — genital lesions risk passing the virus to the baby during vaginal birth — and use shared decision-making about the route of delivery.
• Delay breastfeeding until isolation can end: lesions healed, scabs off, fresh skin formed.
• Offer JYNNEOS vaccination to eligible people, including those pregnant or breastfeeding, and prophylaxis or treatment when indicated.

Limits

Data on exposure and HIV status were often missing; the pregnant group was small; and most pregnancies had not yet ended, so outcomes are incomplete. CDC and health departments continue to follow them.

Sources

Based on Oakley LP, Hufstetler K, O'Shea J, et al., "Mpox Cases Among Cisgender Women and Pregnant Persons — United States, May 11–November 7, 2022," MMWR; a work of the United States government in the public domain.