Mpox and Breastfeeding in Sub-Saharan Africa: Clinical, Program, and Policy Recommendations

The goals are two-fold

First of all, prevent Mpox contamination in any breastfeeding woman, and second, put in place specific strategies for those infected for a safe practice of breastfeeding.

For all breastfeeding women

All contact with infected individuals should be avoided, and systematic prevention measures should be ensured by barrier methods. In the event of risky contact with an infected person, post-exposure prophylaxis can be offered to breastfeeding women by vaccination.^[8]

In women infected with Mpox who are at risk of contamination

After diagnosis and screening for Mpox in breast milk by PCR/DNA and, if possible, culture, any assessment will be made on a case-by-case basis. The preferred option is to maintain breastfeeding in resource-limited regions of subSaharan Africa. This position opposes that of developed countries, which recommend stopping breastfeeding from the outset.^[5] Furthermore, mother and co-rooming is to be prioritized to protect the early initiation and continuation of breastfeeding.^[9]

In practice, all visible lesions and pustules on the breast will be covered. Hand hygiene, wearing a mask, and all barrier methods will be ensured before and after any contact, including breastfeeding and care of the baby. In case of unilateral skin lesions on the breast, the mother can extract and discard milk from the affected breast while continuing to breastfeed from the unaffected breast. In the event of bilateral lesions, breast milk can be extracted, pasteurized, and administered by cup. Pasteurization of breast milk can be both time-consuming and stigmatizing, which can make the procedure unsuccessful. Therefore, in case of failure of the previous process, infants aged <6 months and separated from their mother who has Mpox should be fed with donor human milk or appropriate breast milk substitutes (BMS), informed by feasibility, safety, sustainability, cultural context, acceptability to the mother, and service availability. BMS would be authorized in compliance with acceptable, feasible, affordable, sustainable and safe replacement feeding (AFASS) conditions (acceptable, the community does not stigmatize non breastfeeding mothers), feasible, (the mother must be committed to prepare the BMS at any time, affordable (the family should have proven capacity to buy the articifical milk at the indicated prices), sustainable (the BMS must be made available for at least 6 months) and safe (the environment must ensure safety around the prevention of diarrhea and infectious diseases and permanent access to potable water).^[10,11] As a last resort, the possibility of breastfeeding by an uninfected wet nurse is possible. In all cases, monitoring of the mother, particularly of the newborn, will be carried out closely to ensure the absence of infection and contamination in the newborn or infant. Much remains unknown about the passage of the anti-Mpox antibody into breast milk. In addition, in the case of a mother undergoing antiviral treatment, few data are available regarding the passage of this product into breast milk and its possible role as a post-exposure prophylaxis therapy.^[5]