The Indian Council of Medical Research and the National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH) have published seven recommendations for addressing the monkeypox (MPX) infection in pregnant women in India. Doctors said it is time to recommend the development of guidelines for diagnosis and management of MPX in pregnant women and newborns in India based on covid-19 experience.
“There is a need to establish a multidisciplinary team for management of MPX in pregnant women and their newborns and also strengthen public and private healthcare system for MPX outbreak in India,” said Dr Geetanjali Sachdeva, Director, ICMR-NIRRCH and co-author of the publication.
ICMR-NIRRCH successfully implemented the 'National Registry of Pregnant women with COVID-19 (PregCovid registry)' in collaboration with the Medical Education and Drugs Department and BYL Nair Hospital of Municipal Corporation of Greater Mumbai. Based on the experience of the PregCovid registry (https://pregcovid.com/), the authors have recommended strategies for addressing the monkeypox infection in pregnant women in India.
Speaking about the publication, the corresponding author, Dr Rahul Gajbhiye, Scientist D & DBT Wellcome India Alliance Clinical and Public Health Fellow at ICMR NIRRCH said, "We recommend the development of guidelines for diagnosis and management of MPX in pregnant women and newborns in India. We need to involve the global experts engaged in the management of MPX in pregnant women and newborns for developing evidence-based guidelines appropriate for India and low resource settings. These guidelines shall be revised from time to time based on real-time experience from India and global data. We also recommend the development of a registry of pregnant women and their newborns exposed to MPX virus.”
Pregnant or breastfeeding women and younger children are at increased risk of developing severe disease and adverse health outcomes associated with MPX. Children are more prone to MPX-associated complications such as bacterial superinfection, cellulitis, sepsis, abscess, encephalitis, respiratory complications, pneumonia, keratitis, and corneal scarring leading to higher mortality and morbidity. Similarly, women of childbearing age constituting 22.2 % of the total Indian population are vulnerable to MPX and need special attention.
“Cesarean section is recommended in the presence of genital lesions due to MPX and also in the absence of genital lesions. We, therefore, recommend discussing the risk of neonatal MPX infection, and the benefits, and risks of cesarean section with the pregnant woman and her relatives. Although the data is limited, there is a risk of vertical transmission and fetal demise, hence, we recommend close monitoring of pregnant women exposed to the MPX virus in India. Based on the COVID-19 experience, we recommend institutional isolation of both asymptomatic as well as symptomatic MPX-positive pregnant women to ensure maternal and fetal surveillance,” read the recommendations.
Dr Niraj Mahajan, Associate Professor, Obstetrics and Gynaecology at BYL Nair Hospital, Mumbai, and co-author of the study, said in an official statement issued on Wednesday: “For our Indian settings, we recommend discussing the risk of neonatal MPX infection and the benefits and risk of Cesarean section with the pregnant woman and her relatives. Since there is evidence of risk of vertical transmission and fetal demise, we recommend close monitoring to provide appropriate care to the pregnant woman infected with MPX.”
Following recommendations for India:
Awareness and training of healthcare providers in public and private healthcare facilities.
Developing diagnostic laboratories and referral linkages in rural and urban areas and creating facilities for institutional isolation.
Formulation of the evidence-based guidelines for diagnosis and management of pregnant women and neonates necessitates developing a registry of pregnant women and newborns exposed to the MPX virus and their follow-ups.
Establish a multidisciplinary team for management of MPX in pregnant women and newborns (obstetrician, neonatologist, anaesthetist, dermatologist, psychiatrist and other specialists) at tertiary care facilities.
To conduct studies on the safety and efficacy of available antivirals and vaccines for the treatment of MPX in pregnant women.
Genomic surveillance of MPX virus as the virus is reported to be rapidly evolving.
Strengthen public and private health care system for MPX outbreak and epidemic preparedness and response.