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Asymptomatic Monkeypox Virus Infections Among Male Sexual Health Clinic Attendees in Belgium

16 Pages Posted: 21 Jun 2022

See all articles by Irith De Baetselier

Irith De Baetselier

University of Antwerp - Department of Clinical Sciences

Christophe Van Dijck

University of Antwerp - Department of Clinical Sciences

Chris Kenyon

University of Antwerp - Department of Clinical Sciences

Jasmine Coppens

University of Antwerp - Department of Clinical Sciences

Dorien Van den Bossche

University of Antwerp - Department of Clinical Sciences

Hilde Smet

University of Antwerp - Department of Clinical Sciences

Fien Vanroye

University of Antwerp - Department of Clinical Sciences

Laurens Liesenborghs

University of Antwerp - Department of Clinical Sciences

Kadrie Ramadan

University of Antwerp - Department of Clinical Sciences

Tom Platteau

University of Antwerp - Department of Clinical Sciences

Karin Van Looveren

University of Antwerp - Department of Clinical Sciences

Jolien Baeyens

University of Antwerp - Department of Clinical Sciences

Cindy Van Hoyweghen

University of Antwerp - Department of Clinical Sciences

Marjan Mangelschots

University of Antwerp - Department of Clinical Sciences

Sandra Coppens

University of Antwerp - Department of Clinical Sciences

Leo Heyndrickx

University of Antwerp - Department of Clinical Sciences

Johan Michiels

University of Antwerp - Department of Clinical Sciences

Tessa De Block

University of Antwerp - Department of Clinical Sciences

Sheeba Manoharan-Basil

University of Antwerp - Department of Clinical Sciences

Isabel Brosius

University of Antwerp - Department of Clinical Sciences

Kevin K. Ariën

University of Antwerp - Department of Clinical Sciences

Johan Van Griensven

University of Antwerp - Department of Clinical Sciences

Marie Laga

University of Antwerp - Department of Clinical Sciences

Jef Vanhamel

University of Antwerp - Department of Clinical Sciences

Bea Vuylsteke

University of Antwerp - Department of Clinical Sciences

Emmanuel Bottieau

University of Antwerp - Department of Clinical Sciences

Patrick Soentjens

University of Antwerp - Department of Clinical Sciences

Eric Florence

University of Antwerp - Department of Clinical Sciences

Koen Vercauteren

University of Antwerp - Department of Clinical Sciences

Marjan Van Esbroeck

University of Antwerp - Department of Clinical Sciences

More...

Abstract

Background: Monkeypox is transmitted by close contact with symptomatic cases, and those infected are assumed to be uniformly symptomatic. Evidence of subclinical monkeypox infection is limited to a few immunological studies which found evidence of immunity against orthopoxviruses in asymptomatic individuals who were exposed to monkeypox cases. We aimed to assess whether asymptomatic infections occurred among individuals who underwent sexually transmitted infection (STI) screening in a large Belgian STI clinic around the start of the 2022 monkeypox epidemic in Belgium.

Methods: Anorectal and oropharyngeal swabs collected for gonorrhoea/chlamydia screening from May 1 until May 31, 2022 were retrospectively tested by a monkeypox-specific PCR. Cases with a positive PCR result were recalled to the clinic for case investigation, repeat testing and contact tracing.

Findings: In stored samples from 224 men, we identified three cases with a positive anorectal monkeypox PCR. All three men denied having had any symptoms in the weeks before and after the sample was taken. None of them reported exposure to a diagnosed monkeypox case, nor did any of their contacts develop clinical monkeypox. Follow-up samples were taken 21 to 37 days after the initial sample, by which time the monkeypox-specific PCR was negative, likely as a consequence of spontaneous clearance of the infection.

Interpretation: The existence of asymptomatic monkeypox infection indicates that the virus might be transmitted to close contacts in the absence of symptoms. Our findings suggest that identification and isolation of symptomatic individuals may not suffice to contain the outbreak.

Funding Information: No external funding.

Declaration of Interests: No conflicts of interest to declare.

Ethics Approval Statement: The study protocol was approved by the Institutional Review Board of the Institute of Tropical Medicine (1600/22). Written informed consent is available from all asymptomatic cases.

Keywords: Monkeypox virus, asymptomatic, subclinical, transmission, infectiousness, epidemic

Suggested Citation

De Baetselier, Irith and Van Dijck, Christophe and Kenyon, Chris and Coppens, Jasmine and Van den Bossche, Dorien and Smet, Hilde and Vanroye, Fien and Liesenborghs, Laurens and Ramadan, Kadrie and Platteau, Tom and Van Looveren, Karin and Baeyens, Jolien and Van Hoyweghen, Cindy and Mangelschots, Marjan and Coppens, Sandra and Heyndrickx, Leo and Michiels, Johan and De Block, Tessa and Manoharan-Basil, Sheeba and Brosius, Isabel and Ariën, Kevin K. and Van Griensven, Johan and Laga, Marie and Vanhamel, Jef and Vuylsteke, Bea and Bottieau, Emmanuel and Soentjens, Patrick and Florence, Eric and Vercauteren, Koen and Van Esbroeck, Marjan, Asymptomatic Monkeypox Virus Infections Among Male Sexual Health Clinic Attendees in Belgium. Available at SSRN: https://ssrn.com/abstract=4142074 or http://dx.doi.org/10.2139/ssrn.4142074

Irith De Baetselier

University of Antwerp - Department of Clinical Sciences ( email )

Christophe Van Dijck (Contact Author)

University of Antwerp - Department of Clinical Sciences ( email )

Belgium

Chris Kenyon

University of Antwerp - Department of Clinical Sciences ( email )

Jasmine Coppens

University of Antwerp - Department of Clinical Sciences ( email )

Dorien Van den Bossche

University of Antwerp - Department of Clinical Sciences ( email )

Hilde Smet

University of Antwerp - Department of Clinical Sciences ( email )

Fien Vanroye

University of Antwerp - Department of Clinical Sciences ( email )

Laurens Liesenborghs

University of Antwerp - Department of Clinical Sciences ( email )

Kadrie Ramadan

University of Antwerp - Department of Clinical Sciences ( email )

Tom Platteau

University of Antwerp - Department of Clinical Sciences ( email )

Karin Van Looveren

University of Antwerp - Department of Clinical Sciences ( email )

Jolien Baeyens

University of Antwerp - Department of Clinical Sciences ( email )

Cindy Van Hoyweghen

University of Antwerp - Department of Clinical Sciences ( email )

Marjan Mangelschots

University of Antwerp - Department of Clinical Sciences ( email )

Sandra Coppens

University of Antwerp - Department of Clinical Sciences ( email )

Leo Heyndrickx

University of Antwerp - Department of Clinical Sciences ( email )

Johan Michiels

University of Antwerp - Department of Clinical Sciences ( email )

Tessa De Block

University of Antwerp - Department of Clinical Sciences ( email )

Sheeba Manoharan-Basil

University of Antwerp - Department of Clinical Sciences ( email )

Isabel Brosius

University of Antwerp - Department of Clinical Sciences ( email )

Kevin K. Ariën

University of Antwerp - Department of Clinical Sciences ( email )

Johan Van Griensven

University of Antwerp - Department of Clinical Sciences ( email )

Marie Laga

University of Antwerp - Department of Clinical Sciences ( email )

Jef Vanhamel

University of Antwerp - Department of Clinical Sciences ( email )

Bea Vuylsteke

University of Antwerp - Department of Clinical Sciences ( email )

Emmanuel Bottieau

University of Antwerp - Department of Clinical Sciences ( email )

Patrick Soentjens

University of Antwerp - Department of Clinical Sciences ( email )

Eric Florence

University of Antwerp - Department of Clinical Sciences ( email )

Koen Vercauteren

University of Antwerp - Department of Clinical Sciences ( email )

Marjan Van Esbroeck

University of Antwerp - Department of Clinical Sciences ( email )

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