Specimen Collection

Specimen Collection/Transport requirements

Monkeypox is a notifiable disease and probable cases need to be discussed with your local PHU (and clinical microbiologist if you are sending samples outside ADHB / Labtest) first. Please indicate on the form the name of the Medical officer of Health you discussed the case with so that we can inform them of any positive results.

Please adhere to latest New Zealand Ministry of Health guidelines for Infection Prevention and Control when assessing and testing patients with possible monkeypox infection.

• 1 x Specimen swab with thick shaft in UTM/VTM per site sampled (Always Required)

**DO NOT USE NASOPHARYNGEAL swabs**

Lesions may need to be de-roofed in order to collect the lesion fluid and the base of the
lesion swabbed vigorously with a swab with a thick shaft to apply pressure which ensures adequate cellular material is obtained. Up to THREE lesions may be sampled, preferably each lesion at a different stage of development.

Other samples to be considered during discussion with clinical microbiologist/virologist include:

• Throat and/or rectal swab in UTM/VTM
• Dedicated 4ml EDTA blood tube for monkeypox PCR (only recommended if the patient presents early, and with signs of systemic illness such as fever)
• Scab lesions or crust material (send to the laboratory in a sterile pottle with no added UTM)

All specimens should be promptly transported to LabPLUS (stored at 4 ^o C if overnight delay). Note that unlabelled and/or leaking specimens will not be processed.

Turnaround Time: Between 1 day and 2 days

24 - 48 hours from sample receipt into the laboratory.

Assay Method

In-house multiplex PCR

[Orthopox generic and Monkeypox specific targets]

Diagnostic Use and Interpretation

Background of testing/clinical applicability

Monkeypox virus infection is endemic to west and central Africa. Infections emerged in May 2022 through Europe, US and Australia and became a notifiable disease in New Zealand on 6 ^th of June 2022. Outside of traditional endemic areas in west and central Africa person-person transmission is primarily associated with sexual (particularly amongst gay, bisexual, and other men who have sex with men) or household contact with an case.

Whilst endemic infection is associated with systemic illness and a widespread vesicopustular rash affecting the face and limbs more than the truck, It is notable that non endemic cases are presenting atypically with localised pustular, vesicular or ulcerative genital/per-genital rashes and lymphadenopathy +/- fever. The differential diagnosis for atypical presentations may include HSV/VZV, syphilis and molluscum, and for systemic infections, VZV and enterovirus.

See New Zealand Ministry of Health website for up to date epidemiology and case definitions.

Monkeypox is a notifiable disease ; clinicians are reminded to report any suspected cases to the local Medical Officer of Health.

Testing is performed by Virology Department, Level 2 LabPLUS, Auckland City Hospital. During an early verification phase in 2022, samples will be forwarded to VIDRL (Melbourne, Australia) for confirmatory testing until assay verification is complete.

Other related tests

For patients with genital ulcers consider testing for HSV, VZV and Syphilis.

Consider sexual health screening (including HIV) in at risk populations.

Sources for further information

https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON381

https://www.health.govt.nz/our-work/diseases-and-conditions/monkeypox-mpx

https://www.ecdc.europa.eu/sites/default/files/documents/Monkeypox-multi-country-outbreak.pdf

Contact Information

For further information, please contact the Virology Registrar or SMO via email virology @adhb.govt.nz Monday to Friday, 8am to 4pm. Urgent queries should always be called through to the Virology Registrar (021512393) or SMO or if afterhours, the On-Call Clinical Microbiologist via switchboard.

Last updated at 20:23:08 07/10/2022