Clinical presentation, viral shedding, and neutralizing antibody responses of mpox cases in South Korea: Single center experience

Elsevier

Available online 14 May 2024, 105692

Journal of Clinical VirologyAuthor links open overlay panel, , , , , , , , , Highlights•

The MPXV PCR positivity (87.3%) was higher than culture (63.6%) in ALs.

The Ct value at which 50% of overall samples had infectious virus was 31.3.

Viable MPXV could be isolated for up to 15 days after symptom onset.

The MPXV NAb titers against A.2.1 were significantly lower than B.1.1 and B.1.3.

AbstractBackground

A global mpox outbreak occurred in 2022, and a domestic outbreak started in South Korea in April 2023. This study aimed to evaluate the clinical characteristics, viral shedding, and immune response of mpox in South Korea.

Methods

Patients hospitalized with mpox in the National Medical Center between September 2022 and June 2023 were included in this study. Oropharyngeal (OP), anogenital lesion (AL), and skin lesion (SL) swabs and blood samples were collected, and monkeypox virus (MPXV) DNA using real-time polymerase chain reaction (RT-PCR) and culture assays were performed. Neutralizing antibodies (NAbs) against MPXV A.2.1, B.1.1, and B.1.3 were detected using plaque reduction neutralization tests.

Results

Eighteen patients were enrolled, of whom 17 (94.4%) were male, with a median (IQR) age of 32.5 (24–51) years. While nine (50%) were HIV-infected individuals, none of them revealed CD4+ counts less than 200 cells/μL. MPXV DNA was detected in 87.3% and 82.7% of patient's ALs and SLs, respectively, until 2 weeks after symptom onset. While MPXV was isolated for up to 15 days in all three sample types, the culture positivity decreased to 53.8% and 42.9% in ALs and SLs after 10 days, respectively, and 28.6% and 22.2%, respectively, after 2 weeks from symptom onset. The NAb titers against MPXV A.2.1 were significantly lower than those against B.1.1 and B.1.3.

Conclusions

Infectious MPXV was isolated from various anatomical sites up to 15 days after symptom onset. The MPXV NAb response was varied among different lineages, and this implies limited cross-lineage protection.

Keywords

Mpox

monkeypox virus

viral shedding

infectivity

virus culture

immune response

AbbreviationsRT-PCR

real-time polymerase chain reaction

PRNT

plaque reduction neutralization test

© 2024 The Author(s). Published by Elsevier B.V.

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