Viral Loads in Skin Samples of Patients with Monkeypox Virus Infection: A Systematic Review and Meta-Analysis

Abstract

Despite monkeypox (mpox) being a public health emergency, there is limited knowledge about the risk of infectivity from skin viral loads during mpox infection. Thus, the aim of this study was to estimate cutaneous viral loads among mpox patients globally. Several databases, including Cochrane, EBSCOHost, EMBASE, ProQuest, PubMed, Scopus, and Web of Science, and preprint servers were searched concerning skin mpox viral loads in confirmed mpox subjects. In this systematic review and meta-analysis, a total of 331 articles were initially screened after the removal of duplicate entries. A total of nine articles were included in the systematic review and meta-analysis for the overall estimation of viral loads (Ct) using a random-effect model. The pooled cutaneous mpox viral load (lower Ct) was 21.71 (95% CI: 20.68–22.75) with a majority of positivity rates being 100%, highlighting a higher infectivity risk from skin lesions. The current results strongly support that skin mpox viral loads may be a dominant source of rapid transmission during current multi-national outbreaks. This important finding can help in constructing useful measures in relevant health policy.

MPXV DNA kinetics in bloodstream and other body fluids samples

“…Due to its clinical presentation, laboratory confirmation plays a discriminatory role in the diagnosis of MPXV. Various other infections can cause skin affection, and dermal samples should be the first choice for testing the presence of MPXV 16 , 17 . As in previously published studies 8 , 12 , 18 , 19 , we indeed found the highest viral loads (median Ct: 21.2, 95% CI 20.5–22.3) in skin samples with MPXV DNA positivity rate > 90% in samples collected during week 1 and near to 90% in those collected during week 2.…”

A Case of Severe Mpox Complicated with Streptococcus pyogenes Sepsis in a Patient with HIV Infection

“…A recent systematic review and meta-analysis estimated the skin viral burden in Mpox patients including 731 out of 790 confirmed Mpox individuals demonstrating that the pooled skin viral load was 21.71 (95% CI: 20.68–22.75) [ 45 ]. This study postulated that the skin is a viral reservoir and that the elevated Mpox viral loads (lower Ct values: a reverse correlation exists between Ct values and viral loads [ 46 ]) in association with a high rate of cutaneous lesions positive for Mpox indicate a potential transmission route via direct contact with skin lesions [ 45 ].…”

“…A recent systematic review and meta-analysis estimated the skin viral burden in Mpox patients including 731 out of 790 confirmed Mpox individuals demonstrating that the pooled skin viral load was 21.71 (95% CI: 20.68–22.75) [ 45 ]. This study postulated that the skin is a viral reservoir and that the elevated Mpox viral loads (lower Ct values: a reverse correlation exists between Ct values and viral loads [ 46 ]) in association with a high rate of cutaneous lesions positive for Mpox indicate a potential transmission route via direct contact with skin lesions [ 45 ]. Our Spanish colleagues demonstrated that specimens from the oropharynx and rectum contained replication-competent viruses, showing other possible sources of infection; however, the viral DNA loads were lower, suggesting that replication-competent viruses were less common in these samples in comparison to those taken from the skin [ 44 ].…”

“…In particular, one study revealed that paediatric patients had a higher likelihood of requiring admission to the Intensive Care Unit compared to adults [ 49 ]. For these reasons it may be possible to use viral loads in skin samples as a biomarker forMpox severity, or as a predictor for Mpox disease progression and prognosis [ 45 ].…”