Cases of monkeypox continue to appear around the world. According to the World Health Organization (WHO), at least 27 countries, mostly in Europe and North America, have confirmed cases. Other reports found confirmed cases in more than 30.
The situation will not necessarily develop into a pandemic, but there are worrying signs. Perhaps the main concern is that not all cases appear to be linked, and some isolated cases have no clear link to an existing outbreak. This highlights a traceability issue and suggests that many instances of linkage go undetected.
The lack of coordinated tracking efforts, coupled with shortages of testing, has made tracing a major issue during a covid pandemic in all but a handful of countries, undermining efforts to locate and isolate outbreaks. Letting monkeypox escape close scrutiny could be the difference between containing the spread and a pandemic. Monkeypox has been endemic in parts of Africa for decades, but there is no rapid test and detection of the virus is limited to laboratory analysis. Currently, only a few labs have the ability to perform testing for monkeypox, although this may change soon.
Diagnostics companies rush to develop new monkeypox tests
A person who suspects they have a case of monkeypox (for example, after noticing skin lesions) should contact a doctor, who can then contact one of the laboratories that have equipment to test for orthopoxviruses. Experts recommend that labs test for monkeypox from swabs and tissue samples from lesions.
The test does not confirm monkeypox per se, just the presence of orthopoxvirus. Given the current situation, the assumption is that it is monkeypox, and the protocol is to isolate the individual for up to 21 days. If cases increased significantly, more specific testing would be needed to confirm that the virus is in fact monkeypox and not one of its relatives.
Capacity for monkeypox testing is currently limited, but sufficient to meet current demand. In the United States, about 70 laboratories in 46 states have the capacity to test for orthopoxviruses, the family of viruses to which monkeypox belongs, with a test authorized by the Food and Drugs Administration (FDA). In total, these labs can process around 7,000 tests per week.
While this is enough for now, diagnostics companies are already racing to develop faster tests for monkeypox and have announced plans to roll out PCR tests for researchers to increase capacity.
Covid tests – PCR and rapid antigen tests – have proven lucrative for their makers. Swiss diagnostics company Roche, for example, made about $2 billion in revenue from testing in the first quarter of 2022, and is expected to earn $3 billion for the full year. Its US competitor Abbvie is expected to make $4.5 billion in revenue from covid testing this year.
Both companies are currently working on monkeypox PCR tests as demand for covid tests is expected to drop, although monkeypox tests are highly unlikely to be as important. Monkeypox is transmitted by direct contact with wounds and the skin or bodily fluids of a symptomatic person, so it is much easier to avoid than an airborne virus, and it does not offer the possibility of effecting the type widespread and frequent testing that has been recommended with covid .
Several Chinese companies are also developing tests, as is US diagnostics firm Tetracore, which is working on a rapid antigen test. Hopefully, take-along test kits outside of a lab won’t be needed to deal with the current outbreak, but they could be useful in countries where monkeypox has been and remains endemic.