The Challenges of Mpox Research and Diagnostics and the Role of ATCC in Overcoming Them

Logistical challenges in mpox research

One of the primary challenges in mpox research is the virus' close relationship to the variola virus, the causative agent of smallpox.^5,10 This relationship raises concerns about biosafety and biosecurity, making handling MPXV in laboratory settings highly regulated. Researchers must work in high-containment laboratories, such as biosafety level 3 (BSL-3) facilities, which are not always readily available. This limits the number of studies that can be conducted and slows down the pace of research.

The genetic diversity of MPXV strains poses another layer of complexity. Different strains may exhibit varying levels of virulence and transmissibility,^9,12,13 necessitating comprehensive studies across multiple strains to develop sensitive and specific diagnostic tests and broadly effective interventions. However, accessing a wide range of MPXV strains for research can be challenging due to the virus' geographic distribution and the logistical difficulties of transporting infectious materials.^7,17

Conducting research during an outbreak also presents significant logistical challenges. Researchers must navigate rapidly changing situations, often working in resource-limited settings with limited access to necessary laboratory equipment and reagents.^7,8,17 Additionally, the need for rapid data collection and analysis during an outbreak can lead to ethical dilemmas, such as balancing the urgency of research with the need to ensure informed consent and protect participants' rights.

Reliable surveillance and diagnostics rely on validated tests

Effective outbreak preparedness hinges on the ability to detect and monitor cases swiftly.^{5,8,9,12,15-18} For instance, developing and globally distributing validated diagnostic tests enable rapid viral identification, which can lead to protective measures that interrupt transmission. Because MPXV lesions can resemble those of secondary syphilis, herpesvirus infections, or molluscum contagiosum, the accuracy of these diagnostic tests is paramount.^9-10 While rapid point-of-care tests like COVID-19 antigen tests may seem straightforward, their effective use requires an understanding of infection kinetics to guide isolation and quarantine.

Active surveillance is also critical for identifying unrecognized cases, as transmission can occur from individuals with mild or no symptoms. For instance, a 2022 US study by the CDC found evidence of undetected mpox in 1.4% of samples isolated from homeless individuals.¹⁸ Proper case tracking is essential to inform contacts of infected individuals so they can seek post-exposure prophylaxis. Many labs now monitor MPXV nucleic acids in wastewater, a sensitive method to detect viruses like SARS-CoV-2 and poliovirus, sometimes detecting them before human infections.¹⁹ Surveillance also includes air and surface detection in buildings as MPXV can persist on surfaces for weeks, potentially causing infections through contaminated fomites.

Increasing local surveillance and developing a globally accepted monkeypox case definition are crucial. Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for MPXV. The best diagnostic specimens are collected directly from the rash—skin, fluid, or crusts—via vigorous swabbing. However, such testing must be widely available for global surveillance, particularly in low- and middle-income countries. Additionally, as human MPXV cases continue to spread, the risk of reverse zoonosis to pets, livestock, and wildlife grows. Therefore, surveillance of animals in contact with infected individuals is necessary to detect and prevent potential animal reservoirs.

The role of ATCC in supporting mpox global response

ATCC is uniquely positioned to support researchers in overcoming these challenges. ATCC provides high-quality, authenticated biological materials that are essential for conducting robust and reproducible research and product development. By offering a diverse range of products that support MPXV research, ATCC enables scientists to enhance our understanding of virus biology and support the development of reliable diagnostic tests, vaccines, and therapeutics. These products are summarized in Table 1 and are widely used and cited. ^20-38

Table 1: ATCC materials supporting pox virus research and product development

Moreover, ATCC's global distribution network ensures that critical biological materials are accessible to researchers worldwide, even in resource-limited settings. This accessibility is crucial during an outbreak when rapid access to research materials and reliable genome sequence data^8,13,40 can significantly impact the speed and effectiveness of the response.

The challenges of studying mpox are multifaceted, involving scientific, logistical, and ethical considerations. And the actions that the world community must prioritize remain clear:^8-10

1. Collect efficacy data: More data on the effectiveness of vaccines and drugs in infected humans are urgently needed. 
2. Enhance global collaboration: Global partnerships between government authorities and the private sector—particularly in historically endemic/enzootic regions—are essential for making tests, treatments, and vaccines accessible.
3. Expand diagnostic and surveillance capacity: Efforts must be intensified to enhance diagnostic and surveillance systems to identify areas and populations where the virus is present, reducing the risk of resurgence.
4. Protect high-risk groups: People at high risk of severe outcomes (e.g., immunocompromised individuals, untreated HIV patients, pregnant women, and those with inflammatory skin conditions) must be informed about the infection risks and shielded from community transmission of MPXV.
5. Engage affected communities: It's crucial to engage with the hardest-hit communities in a non-stigmatizing manner to foster understanding and acceptance of public health measures.
6. Establish research repositories: Repositories of mpox isolates and clinical samples, including blood, fluids, tissues, and lesion material, must be established to support research efforts.

In a world where infectious diseases can spread rapidly across borders, the importance of organizations like ATCC cannot be overstated. Their contributions to mpox research help address current challenges and strengthen our preparedness for future outbreaks, ensuring the global community is better equipped to respond to emerging infectious diseases.

Did you know?

ATCC’s quantitative synthetic molecular standard for monkeypox virus (ATCC^® VR-3270SD™) can be safely handled under BSL-1 conditions. Learn more about the development and application of this standard in our application note.

References

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