Milk Banking and Monkeypox

The World Health Organization has declared the current monkeypox outbreak, with more than 16,000 cases reported from 75 countries, as a global health emergency on 23 July 2022¹. The Centers for Disease Control and Prevention (CDC) has reported more than 42,000 cases from 95 countries as of 22 August 2022².

The monkeypox virus is closely related to the small pox virus and can spread to humans from close contact with infected wild animals. It normally occurs mainly in parts of west or central Africa. However, in 2022, the outbreak has spread rapidly around the world, affecting several countries in Europe, America and Asia where monkeypox is not usually found^1,3. The Ministry of Health has reported 15 cases in Singapore as of 19th August 2022 ³.

The virus can spread from person to person through close physical or sexual contact, exposure to respiratory droplets (coughs or sneezes), or contact with blood, body fluids, blisters, scabs, bedding, towels, clothing of an infected individual^1,3.

Symptoms occur 5 to 21 days after exposure and can range from mild to severe^1,3.

Early symptoms include^1,3:

• Fever
• Headache
• Muscle aches
• Backache
• Swollen glands
• Shivering
• Extreme tiredness

This is followed by a rash within 1-5 days, which can look like chickenpox. Initially, raised spots appear which then develop into blisters. These eventually crust, then dry up and fall off. The rash often appears on the face, palms of the hands, soles of the feet, throat, genitals or anal regions of the body.

An infected person remains infectious until all the lesions have dried and fallen off and a new layer of skin is formed underneath. Although most people recover within 2 to 3 weeks from monkeypox, young children and infants, immunocompromised individuals and pregnant women are more at risk of experiencing severe symptoms.

Monkeypox and breastfeeding:

It is currently unknown if the monkeypox virus or antibodies are present in the breast milk of lactating women who have monkeypox infection⁴. However the virus can be transmitted to the newborn via close contact and cases of newborns with monkeypox infection, some severe, have been reported.

Hence the CDC recommends that newborns of infected mothers should be separated from their mothers - that means no skin to skin contact, no complete rooming in and no breastfeeding, until all the skin lesions have healed and fallen off ⁴.

During this time, mothers should express their milk and discard it, to keep up the milk production.

Transmission is likely via skin lesions if directly breastfeeding. Mothers may choose to breastfeed after consulting their healthcare providers. Strict precautions such as wearing a mask and covering the skin lesions are necessary if a mother chooses to continue breastfeeding.

Mothers who decide to temporarily stop breastfeeding, can contact the KK Human Milk Bank for pasteurised donor human milk (PDHM) for their baby. Please note that this will be subject to availability and feasibility of supplying PDHM without exposing milk bank staff to the infection.

Monkeypox and milk donation:

The KK Human Milk Bank is screening all donors for potential exposure to monkeypox. Donors with history of exposure will be advised to stop donating for 21 days from the date of exposure. Infected donors are to stop donating milk until all their lesions have dried up and fallen off.

You may contact the KK Human Milk Bank (KKHMB) via:

Phone: 6394-1986
Email: milkbank@kkh.com.sg

KKHMB located at:

KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Level 2, Women’s Tower

Operating hours:
Monday to Friday (except public holidays) 8.30am to 5.00pm.
(Lunch hour: 1.00pm to 2.00pm)

References:

1. WHO, June 2022. Clinical management and infection prevention and control for monkeypox – Interim rapid response guidance. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.
2. 2022 Monkeypox outbreak Global Map.https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html.
3. Ministry of Health, Singapore, Monkeypox. moh.gov.sg/diseases-updates/monkeypox.
4. Clinical considerations for Monkeypox in people who are pregnant or breastfeeding. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pregnancy.html