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The monkeypox epidemic shares many qualities of past epidemics. Learning from the negative outcomes that public health communication faced in the past can make sure this epidemic doesn’t end up as badly as it could.

Human infections with monkeypox can carry a high risk of congenital infection, loss of pregnancy, and maternal morbidity and mortality. Prior to the current spread of monkeypox, women with the disease who had miscarried were found to have carried stillborn fetuses with skin rashes and monkeypox DNA found in the fetal tissue, confirming vertical transmission of the virus. This article, published in The Lancet, proposes a clinical management algorithm for pregnant women with suspected monkeypox virus exposure.

Because of the effects of monkeypox on pregnant women, clinicians must remain highly suspicious of any women presenting with lymphadenopathy and vesiculopustular rash, even if there are no apparent epidemiological links. Fetal ultrasound monitoring is required in cases of monkeypox in the mother, and additional management is required in cases of anomalies such as fetal hepatomegaly. Because of additional risks to the fetus, pregnant women with an exposure risk should be monitored even if they do not exhibit symptoms.

The authors go on to flesh out their algorithm in more detail and provide guidelines on treatment for those that have monkeypox, including tecovirimat and vaccinia immune globulin for severely ill pregnant women. Due to the rare risk of fetal vaccinia from the ACAM2000 vaccine, patients should be counseled prior to administration. They conclude by noting that delivery and post-delivery cases should be monitored extensively as well, due to an increased risk of complications.

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Dashraath, P., Nielsen-Saines, K., Mattar, C., Musso, D., Tambyah, P., & Baud, D. (2022). Guidelines for pregnant individuals with monkeypox virus exposure. The Lancet, 400(10345), 21-22.

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