Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain.
Journal
The Lancet. Infectious diseases
ISSN: 1474-4457
Titre abrégé: Lancet Infect Dis
Pays: United States
ID NLM: 101130150
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
received:
19
10
2022
revised:
06
11
2022
accepted:
11
11
2022
medline:
28
3
2023
pubmed:
16
12
2022
entrez:
15
12
2022
Statut:
ppublish
Résumé
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. 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. 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 log 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. University Hospital Germans Trias i Pujol and the YoMeCorono. For the Spanish translation of the abstract see Supplementary Materials section.
Sections du résumé
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 log
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.
FUNDING
University Hospital Germans Trias i Pujol and the YoMeCorono.
TRANSLATION
For the Spanish translation of the abstract see Supplementary Materials section.
Identifiants
pubmed: 36521505
pii: S1473-3099(22)00794-0
doi: 10.1016/S1473-3099(22)00794-0
pmc: PMC9977560
pii:
doi:
Types de publication
Observational Study
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
445-453Investigateurs
José Ramón Santos
(J)
Lucía Bailón
(L)
Susana Benet
(S)
Jorge Arroyo Andres
(J)
Lorena Calderón Lozano
(L)
María Carrasco Díaz
(M)
Carla Budria Serrano
(C)
Enola Crespillo Galán
(E)
Ana Isabel Parra Manzano
(AI)
Pamela Nef Rabadán
(P)
Laura Muntané
(L)
Cristina Sánchez-Lafuente Doncel
(C)
Yesinei Marina Marrero Pueo
(YM)
Aroa Muñoz Quinto
(A)
Marlon Acosta
(M)
Patricia Alvarez
(P)
Maider Arando
(M)
Jorge N García
(JN)
Arnau Monforte
(A)
Yolanda Maltas Hidalgo
(Y)
Ramona Hervas Perez
(R)
Laura Clotet Romero
(L)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of interests We declare no competing interests.