妊娠期猴痘：當前爆發的最新情況
資料來源：www.thelancet.com/infection 第 22 卷 2022 年 11 月 / 財團法人台灣紅絲帶基金會編譯
2022 年 9 月 1 日，當前全球爆發的猴痘病例數超過 52,000 例。社區傳播正在影響包括孕婦和新生兒在內的被認為具有嚴重疾病高風險的人群，儘管到目前為止人數很少。截至 2022 年 9 月 2 日，全球已報告 10 例孕婦猴痘病例，主要是透過當地新聞媒體而非醫學或公共衛生出版物，其中 2022 年 7 月 23 日在美國報告了首例病例。根據現有信息，沒有發生垂直傳播；新生兒接受了預防性牛痘免疫球蛋白，沒有患上猴痘。
2022 年 8 月 4 日，巴西聖保羅政府宣布，兩名孕婦被診斷出患有猴痘，並正在接受衛生保健專業人員的監測。到 8 月 26 日，巴西衛生當局共報告了 9 名孕婦。懷孕期間的病例（聖保羅 4 例，里約熱內盧 3 例，米納斯吉拉斯州 1 例，塞阿拉州 1 例）。到 9 月 1 日，8 例猴痘 PCR 確診，而塞阿拉的婦女檢測結果為陰性。8 月 5 日，聖保羅當地一家報紙報導說，一名受感染的孕婦已經過了傳播階段，母嬰情況穩定，但沒有垂直傳播的信息。在米納斯吉拉斯州，26 歲的感染猴痘的孕婦於8月4日因皮損入院，8月14日產下健康嬰兒，出生後與嬰兒隔離，8月17日健康出院。無垂直傳播；新生兒沒有症狀，但在母親出院時仍在醫院。
令人欣慰的是，到目前為止，在孕婦中報告的猴痘感染似乎都不是嚴重的，也沒有證據顯示孕婦比非孕婦患有更嚴重的疾病或更糟糕的結果。然而，迫切需要一個國際登記或報告系統，以更好地了解猴痘的病程、管理、治療和結果，以及疫苗接種在高危人群，包括——母親胎兒二元組合中的安全性和有效性，以便為全世界的患者提供準確的建議和循證照護。不幸的是，我們目前不得不依靠新聞媒體提供無法從外部驗證的稀疏信息。然而，目前在非流行國家與流行國家報告的妊娠期猴痘感染數量更高，突出了國際社會數十年來在流行國家對此類傳染病的忽視。如果在當前的猴痘爆發中有需要吸取的教訓，我們就沒有吸取到教訓。
AK 和 PO’B 是皇家婦產科學院的成員，該小組正在制定妊娠期猴痘指南。 PO’B 是皇家婦產科學院的副院長。所有其他作者聲明沒有競爭利益。
*Asma Khalil, Athina Samara, Pat O’Brien, Conrado Milani Coutinho, Geraldo Duarte, Silvana Maria Quintana, Shamez N Ladhani. akhalil@sgul.ac.uk
英國倫敦，聖喬治醫院 (AK) 英國倫敦，聖喬治大學分子與臨床科學研究所，婦產科胎兒醫學科 (AK) ； 血管生物學研究中心、小兒傳染病研究組和疫苗研究所、感染與免疫研究所 (SNL)；瑞典斯德哥爾摩卡羅林斯卡學院婦女和兒童健康部（AS）；瑞典斯德哥爾摩卡羅林斯卡大學醫院 Astrid Lindgren 兒童醫院新生兒科（AS）；英國倫敦皇家婦產科學院 (PO’B)；英國倫敦大學學院醫院 NHS 基金會信託基金婦女健康部 (PO’B)；巴西聖保羅大學里貝朗普雷圖醫學院婦產科、臨床醫院 (CMC) 和婦產科 (GD, SMQ)；英國倫敦，英格蘭公共衛生，免疫和對策司 (SNL)；英國倫敦，皇家兒科和兒童健康學院，英國兒科監測部門 (SNL)
Monkeypox in pregnancy: update on current outbreak
www.thelancet.com/infection Vol 22 November 2022
The monkeypox case count in the current global outbreak surpassed 52 000 on Sept 1, 2022. Community transmission is affecting people considered to be at high risk of severe disease, including pregnant women and neonates, albeit in small numbers so far. As of Sept 2, 2022, ten cases of monkeypox in pregnant women have been reported worldwide, mostly via local news media rather than medical or public health publications, with the first case reported in the USA on July 23, 2022.1 Based on available information, vertical transmission did not occur; the neonate received prophylactic vaccinia immunoglobulin and did not develop monkeypox disease.
On Aug 4, 2022, the Government of São Paulo, Brazil, announced that two pregnant women had been diagnosed with monkeypox and were being monitored by healthcare professionals.2,3 By Aug 26, the Brazilian health authorities had reported a total of nine cases in pregnancy (four in São Paulo, three in Rio de Janeiro, one in Minas Gerais, and one in Ceará).2 Eight had monkeypox PCR-confirmed by Sept 1, whereas the woman in Ceará tested negative.2 On Aug 5, a local newspaper in São Paulo reported that one of the infected pregnant women had passed the transmission phase, with both mother and baby in a stable condition, but there was no information on vertical transmission.4 In Minas Gerais, the 26-year-old pregnant woman with monkeypox presented to hospital with skin lesions on Aug 4 and gave birth to a healthy infant on Aug 14.5 She was isolated from her baby after birth and discharged healthy on Aug 17. There was no vertical transmission; the neonate was asymptomatic but remained in hospital when the mother was discharged.
Reassuringly, it appears that, so far, none of the monkeypox infections reported in pregnant women have been severe, and there has been no evidence that pregnant women have more severe disease or worse outcomes than non-pregnant people. There is, however, an urgent need for an international registry or reporting system to better understand the course, management, treatment, and outcomes of monkeypox, as well as the safety and effectiveness of vaccination, in populations at high risk, including the mother–fetus dyad, so that patients worldwide can be provided with accurate advice and evidence-based care. Unfortunately, we are currently having to rely on news outlets providing sparse information that is not externally verifiable. Nevertheless, a higher number of monkeypox infections in pregnancy have now been reported in non-endemic versus endemic countries, highlighting decades of neglect by international communitiesof such infectious diseases in endemic countries. If there are lessons to be learnt in the current monkeypox outbreak, we are failing to learn them.
AK and PO’B are members of the Royal College of Obstetricians and Gynaecologists’ group developing guidance on monkeypox in pregnancy. PO’B is VicePresident of the Royal College of Obstetricians and Gynaecologists. All other authors declare no competing interests. *Asma Khalil, Athina Samara, Pat O’Brien, Conrado Milani Coutinho, Geraldo Duarte, Silvana Maria Quintana, Shamez N Ladhani akhalil@sgul.ac.uk Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George’s Hospital (AK), Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute (AK), and Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity (SNL), St George’s University of London, London SW17 0QT, UK; Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden (AS); Department of Neonatology, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden (AS); The Royal College of Obstetricians and Gynaecologists, London, UK (PO’B); Department of Women’s Health, University College London Hospitals NHS Foundation Trust, London, UK (PO’B); Department of Gynecology and Obstetrics, Hospital das Clínicas (CMC) and Department of Gynecology and Obstetrics (GD, SMQ), Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; Immunisation and Countermeasures Division, Public Health England, London, UK (SNL); British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK (SNL)