article · Pathogens
Human mpox cases are rising in Africa, with the Democratic Republic of the Congo bearing the highest burden. Clinical assessments can overestimate infections, while PCR tests on blood samples often underestimate them. A Luminex-based multiplex antibody assay was assessed on 463 leftover blood samples from 174 outbreaks between 2013 and 2022 to examine if serology could complement PCR and assist outbreak investigations. PCR identified 157 samples as positive, while 124 had antibodies to at least one of three mpox peptides. Seropositivity was significantly higher in PCR-positive samples than in PCR-negative ones. Combining serology with PCR identified 66 extra cases, raising the overall infection rate from 33.9% to 48.2%. This combined approach confirmed mpox in 14 additional health zones and 23 additional outbreaks.
Diagnosing mpox accurately is vital for halting transmission. PCR often misses infections when applied to routine blood samples. Demonstrating that antibody testing detects missed cases allows public health authorities to better map outbreak zones and understand transmission, highlighting a clear necessity for improved, rapid diagnostic tools in regions with high disease burdens.
This work points towards applications in diagnostic test development, specifically multi-target assays that combine molecular and serological detection for outbreak surveillance. Intended users include public health agencies, diagnostic laboratories, and epidemiologists. The research demonstrates an applied, retrospective validation on clinical outbreak samples, but real-world field deployment will depend on translating these laboratory multiplex methods into rapid, on-site testing formats.
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Human Mpox cases are increasingly reported in Africa, with the highest burden in the Democratic Republic of Congo (DRC). While case reporting on a clinical basis can overestimate infection rates, laboratory confirmation by PCR can underestimate them, especially on suboptimal samples like blood, commonly used in DRC. Here we used a Luminex-based assay to evaluate whether antibody testing can be complementary to confirm cases and to identify human transmission chains during outbreak investigations. We used left-over blood samples from 463 patients, collected during 174 outbreaks between 2013 and 2022, with corresponding Mpox and VZV PCR results. In total, 157 (33.9%) samples were orthopox-PCR positive and classified as Mpox+; 124 (26.8%) had antibodies to at least one of the three Mpox peptides. The proportion of antibody positive samples was significantly higher in Mpox positive samples (36.9%) versus negative (21.6%) (<i>p</i> < 0.001). By combining PCR and serology, 66 additional patients were identified, leading to an Mpox infection rate of 48.2% (223/463) versus 33.9% when only PCR positivity is considered. Mpox infections were as such identified in 14 additional health zones and 23 additional outbreaks (111/174 (63.8%<i>)</i> versus 88/174 (50.6%)). Our findings highlight the urgent need of rapid on-site diagnostics to circumvent Mpox spread.
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DOI: 10.3390/pathogens12070916
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