Immunisation and preventive measures against mpox in pregnant women and children: A scoping review

Mpox (monkeypox) poses disproportionate risks to pregnant women and children, yet evidence on immunisation and prevention in these groups remains limited. This scoping review mapped and synthesised existing evidence on vaccines and non-pharmaceutical preventive measures for mpox in pregnant women and children, to assess reported effectiveness, and to identify implementation barriers and facilitators. Peer-reviewed and Grey literature were searched in PubMed, Scopus, and Google for records published since 2008; databases were last searched on 19 September 2025. Screening and data extraction followed a pre-specified protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework. Key themes included immunisation strategies, preventive measures, effectiveness, barriers, and facilitators. Forty-eight peer-reviewed articles and 16 Grey literature sources were included. Third-generation non-replicating vaccines (MVA-BN/JYNNEOS/Imvanex/IMVAMUNE) were consistently recommended for pregnant women and children because of their favourable safety profiles. Observational and programmatic estimates of vaccine effectiveness (single dose 36-86%; two doses up to approximately 89%) came almost entirely from adults, and no effectiveness estimate specific to pregnant women or children was identified. No source reported vaccine use by trimester, and paediatric data were limited to small studies. Ring vaccination and post-exposure prophylaxis (PEP) were supported mainly by adult data. Major barriers included limited vaccine supply and cold-chain and logistical constraints in low- and middle-income countries (LMICs), vaccine hesitancy driven by safety concerns, particularly in pregnancy, and the absence of randomised trials in pregnant women and children. Few sources were centred on Africa or other LMICs. Facilitators included international coordination, targeted surveillance, flexible delivery strategies such as intradermal dosing, and integration with maternal and child health services. Priorities include prospective safety and immunogenicity studies in pregnancy and childhood, equitable vaccine access in LMICs, and tailored risk communication to address hesitancy.