Readying Our Defenses: U.S. Labs Should Prepare for a Possible Mpox Surge

If the COVID-19 pandemic has taught the healthcare industry anything, it’s that we must take action during peacetime so that we are prepared in the event of a crisis. We’ve learned the hard way how rapidly disease can spread across continents with devastating effects.

Since the mpox outbreak was declared a public health emergency by the African Centers for Disease Control and Prevention in August, public health officials and industry leaders have grown increasingly concerned about its potential impact, globally and in the U.S. – and understandably so. Mpox, formerly referred to as monkeypox, continues to spread at an alarming rate, with nearly 25,000 suspect cases and more than 640 deaths across Africa this year. 

The number of mpox cases in Africa has surpassed the total cases recorded in all of 2023, with infection spreading to more countries. For now, however, the outbreak remains primarily localized to Central Africa – mainly the Democratic Republic of Congo and the surrounding countries of Burundi, Kenya, Rwanda, and Uganda.

A concerning aspect of the current outbreak is that it’s largely driven by the clade I variant of the virus – specifically clade Ib – which can cause more severe disease and is associated with a mortality rate of 3-10%. Clade Ib also appears to be more contagious, spreading through more routine contact, especially among young children. 

Though the virus can be transmitted to people through contact with an infected animal, the current outbreak is being primarily fueled through human-to-human transmission. Following infection, mpox can cause a flu-like illness and often leads to the development of fluid-filled pustules or lesions and swollen lymph nodes. The virus can be spread to others through direct contact with an infected lesion, body fluids or contaminated material, like clothing or bedding. Similar to the mpox clade II outbreak in 2022, sexual transmission is a primary driver of infection during the current outbreak with clade Ib. It is likely that mpox will need to be considered along with other common sexually transmitted infections, like gonorrhea, chlamydia, and syphilis.

While there is the possibility that mpox can be spread through respiratory droplets produced during breathing or speaking, it’s believed to be a very rare form of transmission, and likely requires prolonged exposure for transmission to occur through this route.

Mobilizing Testing Capabilities Before There is Widespread Transmission

Because mpox is not transmitted efficiently through the respiratory route, and it does not appear that asymptomatic individuals are a source of transmission, it is very unlikely that mpox will cause a global pandemic similar to COVID-19. However, public health and clinical labs in the U.S. play a significant role in controlling the spread of infectious diseases. To prepare for a possible surge in mpox cases, it is essential that diagnostic test manufacturers, public health officials and clinical laboratories begin taking the following steps:

1. Expand testing options. In 2022, the U.S. CDC partnered with select large reference laboratories to expand testing capabilities in the nation. This was done by allowing these reference laboratories to perform the mpox real-time PCR assay that had been developed by the CDC. This represented an important first step in a national strategy to respond to emerging public health threats. We should expand on this approach, by establishing a close partnership between public health, diagnostic test manufacturers and clinical labs to rapidly develop and deploy novel means of diagnosing novel and emerging pathogens. It is important to develop rapid and accurate point-of-care tests, as well as high-throughput tests that can be performed in public health labs and hospital-based clinical laboratories. We need testing options that can provide answers where patients are located, so that rapid patient-management decisions can be made.
2. Increase testing capacity. This includes stockpiling and placing essential testing equipment and kits in more clinical labs across the country. Similar to the National Guard that the U.S. military has established, we need clinical labs that are “at the ready” to bring up testing for an emerging pathogen before there is widespread transmission. We also need to establish a national guard of trained laboratory staff  who can be deployed to testing sites, if necessary.
3. Enhance surveillance systems. By expanding the network of testing, we will enhance our surveillance for novel and emerging public health threats and be able to respond in a more rapid and effective manner. This will require the nation to invest in more robust data-sharing mechanisms that can assist in identifying and tracking cases, , and monitoring trends. As at-home and point-of-care tests become available, we will need to develop and implement effective means of capturing and transmitting the results of these tests to public health officials to track spread.
4. Strengthen communication channels. Gone are the days when healthcare organizations and public health can function within siloes. The world is too small, and a disease in one corner of the world can be in our backyard within 24 hours. An outbreak of a novel or emerging pathogen in one nation should prompt rapid communication to other countries, with deployment of needed resources (e.g., tests, vaccines). Clear lines of communication and ongoing dialogue between diagnostic test manufacturers, public health officials and clinical laboratory leaders is needed to prepare for and rapidly respond to an emerging health threat.
5. Educate the public. Healthcare officials and laboratory leaders play an important role in amplifying credible messaging about symptoms, prevention, and the role of diagnostic testing. This includes the need to develop educational materials on the advantages and limitations of various tests, such as lab-based versus at-home testing options. Laboratory leaders need to be at the frontlines of the national media and social media outlets to combat misinformation and provide a trusted source of reliable and accurate information when an outbreak, such as mpox, occurs.

A penny towards prevention is worth a pound of cure. This is what the global health community must take to heart. We must collectively demonstrate that we have learned a lesson from the COVID-19 pandemic. It is not a matter of “if”, but “when” another infectious disease will cause another pandemic. If it’s not mpox, it might be avian influenza or another pathogen waiting to be discovered. We must invest now and develop the preparedness playbook that will allow us to rapidly respond to a future, invisible enemy.

Photo Credit: ID 335134791 © Edgars Sermulis | Dreamstime.com