Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain

Background Monkeypox DNA has been detected in skin lesions, saliva, oropharynx, urine, semen, and stool of patients infected during the 2022 clade IIb outbreak; however, the viral dynamics within these compartments remain unknown. We aimed to characterise the viral load kinetics over time in various...

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Authors: Suñer, Clara, Folgueira López, María Dolores, Ortiz Romero, Pablo Luis, Mitjà, Oriol
Format: article
Publication Date:2023
Country:España
Institution:Universidad Complutense de Madrid (UCM)
Repository:Docta Complutense
Language:English
OAI Identifier:oai:docta.ucm.es:20.500.14352/131095
Online Access:https://hdl.handle.net/20.500.14352/131095
Access Level:Open access
Keyword:Ciencias Biomédicas
Enfermedades infecciosas
3201.06 Dermatología
3205.05 Enfermedades Infecciosas
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spelling Viral dynamics in patients with monkeypox infection: a prospective cohort study in SpainSuñer, ClaraFolgueira López, María DoloresOrtiz Romero, Pablo LuisMitjà, OriolCiencias BiomédicasEnfermedades infecciosas3201.06 Dermatología3205.05 Enfermedades InfecciosasBackground Monkeypox DNA has been detected in skin lesions, saliva, oropharynx, urine, semen, and stool of patients infected during the 2022 clade IIb outbreak; however, the viral dynamics within these compartments remain unknown. We aimed to characterise the viral load kinetics over time in various parts of the body. Methods This was an observational, prospective, multicentre study of outpatients diagnosed with monkeypox in two hospitals and two sexual health clinics in Spain between June 28, 2022, and Sept 22, 2022. Men and women aged over 18 years were eligible if they reported having symptom onset within the previous 10 days of presentation, and were ineligible if disease was severe enough to be admitted to hospital. Samples were collected from five body locations (skin lesions, oropharynx, rectum, semen or vagina, and a dried blood spot) at six time points up to 57 days after the screening visit. Samples were analysed by quantitative PCR and a subset by cell culture. The primary endpoint was time from symptom onset to viral DNA clearance. Findings Overall, 1663 samples were collected from 77 study participants. 75 (97%) participants were men, the median age was 35·0 years (IQR 29·0–46·0), and 39 (51%) participants were living with HIV. The median time from symptom onset to viral clearance was 25 days (95% CI 23–28) in the skin lesions, 16 days (13–19) in the oropharynx, 16 days (13–23) in the rectum, 13 days in semen (9–18), and 1 day in blood (0–5). The time from symptom onset to viral clearance for 90% of cases was 41 days (95% CI 34–47) in skin lesions and 39 days (27–56) in semen. The median viral load in skin lesions was 7·3 log10 copies per mL (IQR 6·5–8·2) at baseline, compared with 4·6 log10 copies per mL (2·9–5·8) in oropharyngeal samples, 5·0 log10 copies per mL (2·9–7·5) in rectal samples, 3·5 log10 copies per mL (2·9–4·7) in semen samples, and 4·0 log10 copies per mL (4·0–4·0) in blood specimens. Replication-competent viruses were isolated in samples with high DNA levels (>6·5 log10 copies per mL). Interpretation In immunocompetent patients with mild monkeypox disease, PCR data alone would suggest a contact isolation period of 3 to 6 weeks but, based on detection of replication-competent virus, this time could be reduced. Based on findings from this cohort of patients, semen testing and prolonged use of condoms after recovery from monkeypox might not be necessary.ElsevierUniversidad Complutense de Madrid20232023-04-0120232023-04-01journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.14352/131095reponame:Docta Complutenseinstname:Universidad Complutense de Madrid (UCM)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:docta.ucm.es:20.500.14352/1310952026-06-02T12:44:21Z
dc.title.none.fl_str_mv Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain
title Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain
spellingShingle Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain
Suñer, Clara
Ciencias Biomédicas
Enfermedades infecciosas
3201.06 Dermatología
3205.05 Enfermedades Infecciosas
title_short Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain
title_full Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain
title_fullStr Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain
title_full_unstemmed Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain
title_sort Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain
dc.creator.none.fl_str_mv Suñer, Clara
Folgueira López, María Dolores
Ortiz Romero, Pablo Luis
Mitjà, Oriol
author Suñer, Clara
author_facet Suñer, Clara
Folgueira López, María Dolores
Ortiz Romero, Pablo Luis
Mitjà, Oriol
author_role author
author2 Folgueira López, María Dolores
Ortiz Romero, Pablo Luis
Mitjà, Oriol
author2_role author
author
author
dc.contributor.none.fl_str_mv Universidad Complutense de Madrid
dc.subject.none.fl_str_mv Ciencias Biomédicas
Enfermedades infecciosas
3201.06 Dermatología
3205.05 Enfermedades Infecciosas
topic Ciencias Biomédicas
Enfermedades infecciosas
3201.06 Dermatología
3205.05 Enfermedades Infecciosas
description Background Monkeypox DNA has been detected in skin lesions, saliva, oropharynx, urine, semen, and stool of patients infected during the 2022 clade IIb outbreak; however, the viral dynamics within these compartments remain unknown. We aimed to characterise the viral load kinetics over time in various parts of the body. Methods This was an observational, prospective, multicentre study of outpatients diagnosed with monkeypox in two hospitals and two sexual health clinics in Spain between June 28, 2022, and Sept 22, 2022. Men and women aged over 18 years were eligible if they reported having symptom onset within the previous 10 days of presentation, and were ineligible if disease was severe enough to be admitted to hospital. Samples were collected from five body locations (skin lesions, oropharynx, rectum, semen or vagina, and a dried blood spot) at six time points up to 57 days after the screening visit. Samples were analysed by quantitative PCR and a subset by cell culture. The primary endpoint was time from symptom onset to viral DNA clearance. Findings Overall, 1663 samples were collected from 77 study participants. 75 (97%) participants were men, the median age was 35·0 years (IQR 29·0–46·0), and 39 (51%) participants were living with HIV. The median time from symptom onset to viral clearance was 25 days (95% CI 23–28) in the skin lesions, 16 days (13–19) in the oropharynx, 16 days (13–23) in the rectum, 13 days in semen (9–18), and 1 day in blood (0–5). The time from symptom onset to viral clearance for 90% of cases was 41 days (95% CI 34–47) in skin lesions and 39 days (27–56) in semen. The median viral load in skin lesions was 7·3 log10 copies per mL (IQR 6·5–8·2) at baseline, compared with 4·6 log10 copies per mL (2·9–5·8) in oropharyngeal samples, 5·0 log10 copies per mL (2·9–7·5) in rectal samples, 3·5 log10 copies per mL (2·9–4·7) in semen samples, and 4·0 log10 copies per mL (4·0–4·0) in blood specimens. Replication-competent viruses were isolated in samples with high DNA levels (>6·5 log10 copies per mL). Interpretation In immunocompetent patients with mild monkeypox disease, PCR data alone would suggest a contact isolation period of 3 to 6 weeks but, based on detection of replication-competent virus, this time could be reduced. Based on findings from this cohort of patients, semen testing and prolonged use of condoms after recovery from monkeypox might not be necessary.
publishDate 2023
dc.date.none.fl_str_mv 2023
2023-04-01
2023
2023-04-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.14352/131095
url https://hdl.handle.net/20.500.14352/131095
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Docta Complutense
instname:Universidad Complutense de Madrid (UCM)
instname_str Universidad Complutense de Madrid (UCM)
reponame_str Docta Complutense
collection Docta Complutense
repository.name.fl_str_mv
repository.mail.fl_str_mv
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