Monkeypox Virus Detection in Different Clinical Specimen Types

Maan Hasso; Stephen Perusini; Alireza Eshaghi; Elaine Tang; Romy Olsha; Hanyue Zhang; Evelyn Lau; Ashleigh Sullivan; Kirby Cronin; Seyeon Lee; Janet Obando; Cedric DeLima; Sandeep Nagra; Tom Braukmann; Venkata R. Duvvuri; Melissa Richard-Greenblatt; Antoine Corbeil; Julianne V. Kus; Anna Majury; Samir Patel; Jonathan B. Gubbay


Emerging Infectious Diseases. 2022;28(12):2513-2515. 

In This Article

Abstract and Introduction


A global monkeypox outbreak began in May 2022. Limited data exist on specimen type performance in associated molecular diagnostics. Consequently, a diverse range of specimen sources were collected in the initial weeks of the outbreak in Ontario, Canada. Our clinical evaluation identified skin lesions as the optimal diagnostic specimen source.


The rapid emergence of monkeypox in nonendemic regions of the world during 2022 has health systems on alert.[1] Monkeypox is a zoonosis caused by monkeypox virus (MPXV) (genus Orthopoxvirus [OPXV]). MPXV forms 2 distinct clades: clade I (formerly the Congo Basin/Central African clade), associated with higher virulence and greater mortality rate, and clade II (formerly the West African clade), which is responsible for the current global outbreak.[2,3]

The rapid increase in monkeypox cases in nonendemic areas has challenged clinical laboratories. MPXV shedding and transmission are poorly understood, and relevant data to support clinical management and public health response are lacking. Human-to-human transmission occurs by respiratory droplets, direct contact with skin lesions of infected persons, or contact with contaminated fomites.[4] Skin lesions, when present, are presumed to be the primary source of viral shedding. Thus, testing of lesion swab specimens by real-time reverse transcription PCR (RT-PCR) is believed to be optimal for diagnosis.[5,6] MPXV can also be detected in other sites, such as throat, nasopharynx, blood, urine, saliva, and semen.[7]

We investigated detection of MPXV among different clinical specimen types. These specimens were submitted to the provincial reference laboratory for testing in the early weeks of the 2022 outbreak in Ontario, Canada.