Pre- and asymptomatic viral shedding in high-risk contacts of monkeypox cases: a prospective cohort study
Brosius, I.; Van Dijck, C.; Coppens, J.; Vandenhove, L.; Bangwen, E.; Vanroye, F.; Verschueren, J.; Zange, S.; Bugert, J.; Bottieau, E.; Soentjens, P.; van Griensven, J.; Kenyon, C.; Arien, K. K.; Van Esbroeck, M.; Vercauteren, K.; Liesenborghs, L.; ITM MPX consortium,
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AO_SCPLOWBSTRACTC_SCPLOWEpidemiological data suggest that clade IIb monkeypox virus (MPXV) is readily transmitted during sexual contact, even before symptom onset. However, presymptomatic shedding of MPXV remains to be demonstrated. Here, we prospectively followed up 25 individuals after high-risk exposure to MPXV. Daily anorectal, genital, and saliva samples and weekly blood and oropharyngeal samples were collected along with clinical information. During follow-up, 12/18 (66.0%) sexual and 1/7 (14.0%) non-sexual contacts showed evidence of MPXV infection by PCR, five of whom had low viral loads and no typical MPXV symptoms. In 5/6 (83.3%) patients with typical symptoms, viral DNA was detected as early as four days before symptom onset and in three of them, replication-competent virus was found. These findings emphasize the high risk of MPXV transmission during sexual contact and confirm the existence of presymptomatic viral shedding of MPXV. Sexual contacts of an MPXV-infected partner should abstain from sex irrespective of symptoms.
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