Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain, May to June 2022

Peiró-Mestres, Aida; Fuertes, Irene; Camprubí-Ferrer, Daniel; Marcos, María Ángeles; Vilella, Anna; Navarro, Mireia; Rodriguez-Elena, Laura; Riera, J.; Català, Alba; Martínez, Miguel J.; Blanco, José Luis Santiago

doi:10.2807/1560-7917.es.2022.27.28.2200503

Cited by 250 publications

(327 citation statements)

References 12 publications

(16 reference statements)

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“…One challenge in understanding the performance of saliva-based tests is the heterogeneity with which such tests have been used in published case series (5). Our systematic rapid review, however, demonstrated 100% agreement with lesion PCR testing (5, 10, 16-19). That performance may not reflect the true performance of saliva-based tests, however, given the small overall sample size and that all included studies were case series.…”

Section: Discussionmentioning

confidence: 70%

“…Prior studies, however, suggest that viral DNA may be detected in saliva and oropharyngeal specimens (2, 9, 10). One recent report noted 100% (n=12) patients with Human Monkeypox had positive saliva PCR tests (9). Similar findings were reported among a study of 7 individuals diagnosed with Human Monkeypox in 2018 and 2019 (10).…”

Section: Introductionmentioning

confidence: 97%

“…Similar findings were reported among a study of 7 individuals diagnosed with Human Monkeypox in 2018 and 2019 (10). In both studies, many individuals had positive oropharyngeal tests early in the disease course (9, 10). Thus, via early case detection, saliva testing may provide the opportunity to limit infectiousness.…”

Section: Introductionmentioning

confidence: 98%

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Laboratory Validation and Clinical Implementation of Human Monkeypox Saliva-Based Tests

Allan‐Blitz

Carragher

Sukhija-Cohen

et al. 2022

Preprint

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Background: Improved diagnostic capabilities and accessibility are essential for controlling the outbreak of Human Monkeypox. Methods We developed a saliva-based polymerase chain reaction (PCR) for Human Monkeypox, evaluated in vitro test performance, as well as report on clinical implementation of that assay at three testing sites in Los Angeles. Finally, using pre-specified search terms, we conducted a systematic rapid review of PubMed and Web of Science online databases of studies reporting the performance of saliva-based tests for Human Monkeypox. Results Laboratory evaluation of the assay showed in silico inclusivity of 100% for all (n=97) strains of Human Monkeypox, with an analytic sensitivity of 250 copies/mL, as well as 100% agreement compared to known positive and negative specimens. Clinical testing identified 15 cases of Human Monkeypox among 114 individuals screened (13.2%). Of those, 11 (73.3%) reported symptoms, two of whom had not developed a rash. Our systematic rapid review identified 6 studies; 23 patients had tests performed on oropharyngeal specimens 100% of which were in agreement with the PCR test of a lesion swab. Conclusion: Saliva-based PCR tests are potential tools for outbreak control, and further evaluation of the performance of such tests is warranted.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 97%

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Laboratory Validation and Clinical Implementation of Human Monkeypox Saliva-Based Tests

Allan‐Blitz

Carragher

Sukhija-Cohen

et al. 2022

Preprint

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“…Rapidly leveraging wastewater surveillance infrastructure may enhance surveillance for an emerging infectious disease such as monkeypox in real-time with minimal changes in sample collection procedures, however it is unclear how effectively these systems can be used for new outbreaks where viral shedding profiles are still being delineated. Observational studies of patients infected during the current monkeypox outbreak (summer 2022) confirms shedding of viral DNA from saliva, feces, urine, semen, and skin lesions 10,11 . Authors did not report concentrations or mass of viral DNA in their specimens, however reported Cq values from qPCR measurements were low, suggesting high concentrations of MPXV DNA even on day 16 after symptom onset 10 .…”

Section: Introductionmentioning

confidence: 87%

“…Observational studies of patients infected during the current monkeypox outbreak (summer 2022) confirms shedding of viral DNA from saliva, feces, urine, semen, and skin lesions 10,11 . Authors did not report concentrations or mass of viral DNA in their specimens, however reported Cq values from qPCR measurements were low, suggesting high concentrations of MPXV DNA even on day 16 after symptom onset 10 . These data are consistent with reports of MPXV shedding from previous outbreaks in humans 12 and experimental studies in animals [13][14][15][16] that consistently show shedding via these excretions.…”

Section: Introductionmentioning

confidence: 87%

Detection of monkeypox viral DNA in a routine wastewater monitoring program

Wolfe

Duong

Hughes

et al. 2022

Preprint

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Wastewater represents a composite biological sample from the entire contributing population. People infected with monkeypox excrete monkeypox virus DNA via skin lesions, saliva, feces and urine and these can enter the wastewater via toilets, sinks, and shower drains. To test whether monkeypox can be detected and monitored in wastewater during a period when publicly reported monkey cases in the region were increasing, we deployed digital PCR assays that target genomic DNA from the monkeypox virus in our routine, ongoing wastewater surveillance program in the Greater Bay Area of California, USA. We measured monkeypox virus DNA daily in settled solids samples from nine wastewater plants over the period of approximately 4 weeks. During that period, we detected monkeypox virus DNA in wastewater solids at nearly all the wastewater plants we routinely sample. Frequency of occurrence and concentrations were highest at plants serving San Francisco County. To confirm the presence of monkeypox DNA, we used two assays that target distinct sequences on the monkeypox genome on a subset of samples and results from both assays were in close agreement strongly suggesting true positives in the wastewater. Additionally, we show that concentrations of monkeypox DNA is 103 times higher in the solid fraction compared to the liquid fraction of wastewater on a mass-equivalent basis.

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Neurologic Complications of Smallpox and Monkeypox

et al. 2022

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ImportanceOrthopox viruses include smallpox virus, a once feared but now eradicated virus, as well as monkeypox virus. Monkeypox is an emerging virus initially isolated in 1958, previously unrecognized outside sub-Saharan Africa until a worldwide outbreak in May 2022. It is important to review known neurologic consequences of both these viruses, as complications of smallpox may be relevant to monkeypox, though complications of monkeypox may be rarer and perhaps less severe.ObservationsThis was a literature review of the known neurologic complications of smallpox, which include encephalitis, transverse myelitis, and acute disseminated encephalomyelitis among others; historical complications of smallpox vaccination, including postvaccinal encephalomyelitis; and the known neurologic complications of monkeypox, which include headaches and mood disturbances, as well as rare presentations of encephalitis, transverse myelitis, and seizures. Of concern is the possibility of viral persistence and systemic complications in immunocompromised individuals. Also provided were considerations for diagnosis, current treatment, and prevention of monkeypox.Conclusions and RelevanceMonkeypox should be considered in high-risk populations who present with neurologic syndromes. Diagnosis may require serology and polymerase chain reaction testing of blood and spinal fluid. Antiviral therapy should be initiated early in the course of the illness.

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Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain, May to June 2022

Cited by 250 publications

References 12 publications

Laboratory Validation and Clinical Implementation of Human Monkeypox Saliva-Based Tests

Laboratory Validation and Clinical Implementation of Human Monkeypox Saliva-Based Tests

Detection of monkeypox viral DNA in a routine wastewater monitoring program

Neurologic Complications of Smallpox and Monkeypox

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