Maternal and neonatal mpox in Nigeria: a multicentre case series highlighting diagnostic challenges, transmission pathways, and neonatal outcomes
This multicentre case series from southern Nigeria documents three mother–neonate pairs infected with Clade IIb mpox, highlighting the diagnostic challenges of identifying maternal infection without cutaneous lesions, the uncertainty surrounding transmission routes, and the spectrum of neonatal outcomes ranging from full recovery to mortality.
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Viruses that jump from animals to humans have long been a part of life in many parts of the world, but when these infections meet the unique biology of pregnancy, the rules of transmission and survival become far less clear. One such virus is mpox, a cousin of the smallpox virus that causes fever and a distinctive rash of fluid-filled blisters. While scientists have studied how this virus spreads among adults, they know very little about what happens when a pregnant woman catches it, or how the virus might pass to her baby. The virus exists in different genetic groups, and the specific group circulating in Nigeria and causing recent global concern behaves differently than older strains found in other regions. Understanding how this virus moves from a mother to her newborn is critical, because the timing of the infection—whether it happens before birth, during delivery, or immediately after—determines how doctors should treat the family and how they can protect other children.
In southern Nigeria, a team of doctors and researchers recently examined three families where a mother became sick with a suspected viral infection late in her pregnancy, and her newborn baby was later confirmed to have the virus. The study, which looked back at medical records from three different hospitals, reveals a troubling pattern of missed diagnoses and a wide range of outcomes for the infants. In all three cases, the mothers fell ill during the final months of pregnancy or just before giving birth. Two of the women developed the classic symptoms of the virus: a high fever followed by a widespread rash of blisters. The third woman had a fever that went away on its own within two days and never developed a rash. Because the doctors did not suspect the virus at the time, none of the mothers were tested while they were pregnant. It was only after their babies were born and became sick that the connection was made.
The babies in these three families were all boys, and all were born full-term. Each infant stayed healthy for a few days after birth, but then, between the fourth and ninth day of life, they developed high fevers and a severe rash that covered their entire bodies. The rash was not just a few spots; it was a widespread eruption of blisters that appeared on the face, scalp, trunk, limbs, and even the palms of the hands and soles of the feet. Doctors confirmed the diagnosis by swabbing the blisters and testing them in a laboratory, which proved the presence of the virus and ruled out other common causes of rashes in newborns, such as chickenpox. In two of the babies, the test showed a very high amount of virus in their system, indicating a severe infection.
The story of how the virus reached these babies remains a mystery, even after the doctors looked closely at the families. In two of the households, the fathers had also been sick with a similar fever and rash shortly before the mothers fell ill. In one case, the father had healing sores on his skin at the time of the baby's birth and held the newborn immediately after delivery. This raised the possibility that the virus could have been passed from the father to the baby through touch. However, the virus could also have traveled from the mother to the baby through the placenta while the baby was still in the womb, or it could have been passed during the birth process itself. Because the doctors did not test the placenta, the umbilical cord, or the mothers' blood at the time of delivery, they could not determine exactly which path the virus took. This uncertainty is a major gap in knowledge, as the method of transmission would change how doctors manage future cases.
The outcomes for the three families were mixed, highlighting the fragility of newborn health in resource-limited settings. Two of the infants received supportive care, which included keeping them warm, giving them fluids, treating their fever, and cleaning their skin wounds carefully. These two babies eventually recovered completely, with their skin healing and no long-term damage. The third infant, however, faced a different fate. Although he was admitted to the hospital and started on the same supportive care, his family was forced to take him home early because they could not afford to keep him there. Once he left the hospital, his fever did not go away, and he died a few days later. The doctors could not perform an autopsy to find the exact cause of death, but the timeline suggests that the lack of continued medical care was the deciding factor. The mothers in all three cases eventually recovered without major complications, though the one mother who had HIV was already on treatment and remained stable throughout.
This collection of cases offers a rare glimpse into a situation that is usually hidden from view. It shows that a pregnant woman can carry the virus without anyone realizing it, especially if her symptoms are mild or if she does not develop the characteristic rash. It also demonstrates that when a newborn does catch the virus, the infection can be severe and widespread, requiring careful medical attention. The death of one child serves as a stark reminder that even when a disease is treatable with basic supportive care, financial barriers can prevent families from getting the help they need. The study does not claim to have solved the mystery of how the virus passes from mother to child, but it clearly points out that current methods of observation are not enough to tell the whole story. To protect future mothers and babies, doctors in these regions will need to be more alert to the signs of the virus during pregnancy, and researchers will need to conduct more detailed studies that include testing the placenta and the blood of both mother and child to finally map the path of transmission.
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