Longitudinal viral shedding and antibody response characteristics of men with acute infection of monkeypox virus: a prospective cohort study

Abstract

Abstract Background Elucidating the viral and antibody dynamics within the host and the viral dynamics of the environmental fomits is key for the successful public health measures against monkeypox virus (MPXV) infection. In this study, a total of 993 samples from multiple sites of patients and 1,633 samples from environmental fomits of 77 acute MPXV infections (HIV co-infection: N=42) were collected every two to three days and subjected for the detection of MPXV DNA, surface proteins specific antibody and neutralizing titers. Overall, skin lesions showed 100% positive rate of MPXV DNA, followed by rectal swab (88.16%), saliva (83.78%), oropharyngeal swab (78.95%), urine (55.26%)and plasma (31.17%). Positive rate of oropharyngeal swab decreased rapidly after 7 days post symptoms onset (d.p.o), while the rectal swab and saliva maintained close positive rates to the skin lesions. Viral dynamics were similar among skin lesions, saliva and oropharyngeal, withrapid increase to the peak at about 6 d.p.o and then decreased. While for the rectal swab, it peaked at the beginning of symptoms onset, and decreased rapidly with the disease progression. Totally, 52.66% (860/1633) of environmental fomits swabs were positive for MPXV DNA, with highest positive rate (69.89%) and mean viral loads (Ct values of 31.22) from the deposition area. Moreover, the proportion of Ct values between 15-30 maintained high for some fomits like the deposition area, floor and bedside cupboard during the disease progression.High seropositivity against A29L (100%) and H3L (94.74%) were detected, while the high correlation was only found between anti-A29L IgG titer and neutralizing titer. Notably, most of indexes were similar between HIV and Non-HIV participants, except the higher viral loads in the early stage and peak viral from the rectal swabs of the HIV participants. Our results contribute to an improved understanding of viral shedding and antibody response characteristics of acute Mpox. With the ongoing outbreak of Mpox worldwide, these data have profound implications for the diagnosis, treatment, prevention of transmission and development of vaccines for Mpox.