Breastfeeding in the context of mpox

On 14 August 2024, the World Health Organization (WHO) declared mpox a public health emergency of international concern. Certain countries, such as the Democratic Republic of the Congo, have been particularly affected. Questions have been raised about whether mothers should continue to breastfeed during the outbreak. The importance of exclusive breastfeeding for infant survival is widely acknowledged. Equally, the risks associated with withholding breastfeeding and the distress caused by separating the mother-infant pair are well documented, including as a result of lessons learnt from other health crises. It is currently unknown whether the mpox virus or antibodies are present in the breastmilk of breastfeeding mothers with mpox.

These frequently asked questions (FAQs), produced by the Infant Feeding in Emergencies (IFE) Core Group Infectious Disease Taskforce, are intended to provide guidance to breastfeeding mothers and health workers on breastfeeding during the current mpox outbreak.

The FAQs draw on infant and young child feeding recommendations from WHO and the IFE Core Group. Interim mpox guidance was produced by WHO in 2022, which recommended that the decision on whether an infected mother should stop breastfeeding should be assessed on a case-by-case basis. Existing guidance has highlighted the known protective effects of breastmilk and breastfeeding and the harmful effects of the inappropriate use of breastmilk substitutes. It has been stressed that these factors must be given greater weight in a risk/benefit calculation than the potential and unknown risk of infection from mpox in the breastfed infant. 

These FAQs build upon the available evidence regarding the risk of transmitting mpox virus through breastmilk and breastfeeding. The document contains 24 questions, divided into general questions on mpox, scenarios where the mother is confirmed/suspected to have mpox but the infant is negative, scenarios where the mother is negative but the infant is confirmed/suspected to have mpox, scenarios where both the mother and infant are confirmed/suspected to have mpox, and information on mpox vaccinations and breastfeeding. 

The FAQs also include a decision tree, which focuses on when the mother is confirmed/suspected to have mpox but the infant is negative. This visualises how health workers may implement the recommendations outlined in the FAQs as part of their routine delivery of services at community and facility levels. Guidance on infection prevention and control measures, considering the level of exposure and risk, are outlined throughout the FAQs and in the decision-tree. 

It is acknowledged that the guidance on mpox will continue to evolve as more evidence becomes available. Please contact IFE@ennonline.net if you have suggestions for improvements. Readers can also keep up to date with the ongoing discussion and resources on en-net at https://www.en-net.org/forum/question/5125.