Monkeypox: A Laboratory Medicine Perspective

Summary

In this episode of Lab Medicine Rounds, host Justin Kreuter interviews Dr. Matt Binnicker about the monkeypox outbreak, contrasting it with COVID-19. Dr. Binnicker explains that monkeypox spreads primarily through skin-to-skin contact and often via sexual transmission, unlike COVID-19 which is respiratory. The discussion highlights the importance of laboratory testing for diagnosis, the role of clinical labs in handling the outbreak, and the potential for future point-of-care tests. The conversation underscores the critical link between lab medicine and clinical practice in managing infectious diseases.

Takeaways

• 🌟 Dr. Matt Binnicker, Director of Clinical Virology at Mayo Clinic, discusses the monkeypox outbreak, marking it as the largest in recorded history with over 50,000 confirmed cases worldwide.
• 📈 Monkeypox cases have significantly increased, with the U.S. reporting over 20,000 confirmed cases, indicating a substantial outbreak.
• 🔬 Monkeypox is primarily spread through direct skin-to-skin contact and, in many recent cases, through sexual transmission.
• 📍 Unlike COVID-19, which is a respiratory illness, monkeypox presents with a viral prodrome followed by a rash that can mimic other diseases.
• 🧬 The CDC and public health agencies have developed tests to detect monkeypox, with Mayo Clinic being one of five reference laboratories for testing in the U.S.
• 🏥 Most hospital clinical labs are not yet performing monkeypox testing but are sending samples to reference labs or state public health laboratories.
• 📋 The FDA requires emergency use authorization for any new monkeypox tests, paving the way for commercial manufacturers to develop their own tests.
• 🏥🔬 Laboratory medicine professionals play a critical role in diagnosing monkeypox by confirming infections through laboratory testing, which is essential for patient care and disease management.
• 🧪 Viral culture for monkeypox is not recommended due to the risk of aerosolizing the virus and the need for high biosafety level precautions.
• 🏠 The possibility of home test kits for monkeypox is being explored, with potential for point-of-care testing in the future, similar to COVID-19 testing.

Q & A

What is the primary mode of transmission for monkeypox?

Monkeypox is spread primarily through direct skin-to-skin contact, often during sexual transmission, and can also be spread through contact with contaminated objects.

How does the monkeypox outbreak in 2022 compare to previous years?

The 2022 outbreak is the largest monkeypox outbreak in recorded history, with over 50,000 confirmed cases worldwide and over 20,000 in the U.S., significantly larger than previous outbreaks.

What differentiates monkeypox from COVID-19 in terms of symptoms?

Monkeypox causes a viral prodrome with fever and body aches, followed by a rash, whereas COVID-19 primarily causes respiratory illness.

What is the role of laboratory testing in diagnosing monkeypox?

Laboratory testing is crucial for confirming monkeypox infections, as it can present similarly to other diseases. It involves a detailed exposure history, symptoms assessment, and laboratory confirmation.

Why are viral cultures not recommended for monkeypox testing?

Viral cultures for monkeypox pose a significant safety risk to lab personnel due to the potential for aerosolizing the sample, which could lead to infection.

How has the FDA's emergency use authorization process impacted the development of monkeypox tests?

The FDA's emergency use authorization process has opened the door for commercial manufacturers to develop their own tests, which will allow hospital and clinical labs to perform testing in-house.

What is the significance of Mayo Clinic being identified as one of the reference laboratories for monkeypox testing?

Mayo Clinic's identification as a reference laboratory signifies its role in partnering with the CDC to begin testing for monkeypox, contributing to the national response to the outbreak.

How does the process of diagnosing monkeypox compare to COVID-19?

Diagnosing monkeypox involves a three-pronged approach including exposure history, symptoms assessment, and laboratory confirmation, whereas COVID-19 diagnosis often relies on respiratory samples and molecular tests.

What is the potential future for point-of-care testing for monkeypox?

While currently most testing is done in reference labs, the future may see point-of-care tests developed and authorized by the FDA, similar to home test kits for COVID-19.

Why is it important for hospital labs to perform monkeypox testing locally?

Local testing is important for patient care as it allows for quicker diagnosis and treatment, reducing the risk of disease transmission within hospitals or clinics.

How does the monkeypox outbreak highlight the evolving science of laboratory medicine?

The monkeypox outbreak, like COVID-19, demonstrates the dynamic nature of laboratory medicine, where knowledge and practices evolve in real-time based on emerging public health challenges.