Monkeypox: What you need to know about testing for the virus in New Zealand – Stuff

New Zealand has recorded two unconnected cases of monkeypox this week and officials say there is no evidence of community transmission.

Monkeypox is endemic to areas of Central and West Africa but an outbreak was confirmed in May, spreading to more than 50 countries with 9624 cases detected as of July 11.

Two tests have been run in New Zealand so far. The Institute for Environmental Science and Research (ESR) has 500 tests in stock and there is likely to be further stock at other labs, officials say.

So how does monkeypox testing work? How long does it take, who needs to get tested, and do we have capacity?

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The first symptoms of monkeypox are usually headache, acute onset of fever (>38.0C), chills, swollen lymph nodes, muscle and body aches, backache, and tiredness.

After a few days, a characteristic rash usually appears and spreads to other parts of the body, such as the palms of the hands and soles of the feet, inside the mouth, or on the genitalia.

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Two tests for monkeypox have been done in New Zealand to date, both of which were positive.

The monkeypox rash typically evolves in four stages macular (flat), papular (raised), vesicular (raised and filled with clear fluid), to pustular (raised and filled with opaque fluid) before scabbing over and resolving.

To get infected you need to be in close contact (usually skin-to-skin or shared respiratory droplets) with a case while they are infectious.

At this stage, close contacts are asked to monitor for symptoms for three weeks and to isolate if symptoms develop. They would only get a PCR test if a rash developed, the Ministry of Health said.

The incubation period (from infection to onset of symptoms) is usually from six to 13 days but can range from five to 21 days.

Close contacts are not required to strictly quarantine, however they are advised to avoid high-risk settings such as healthcare, childcare and aged care facilities, as well as indoor gatherings such as at bars, restaurants and places of worship, the ministry said.

Close contacts are also advised to avoid sex and kissing; and to avoid close contact with people potentially at higher risk of infection, such as infants, older people and immuno-compromised people.

While you swab your nose or throat for Covid-19, the recommended specimen type for monkeypox is skin lesion material.

This involves taking swabs of a lesions surface and/or exudate (wound fluid), roofs from more than one lesion, or lesion crusts from the rash itself.

Confirming someone has monkeypox is similar to confirming Covid-19 infection via a PCR test.

Polymerase chain reaction (PCR) is a method to rapidly make (or amplify) millions to billions of copies of a very small specific segment of DNA, which can then be studied in greater detail.

The test detects DNA at varying concentrations, which indicates whether a result is either positive, negative, or inconclusive, to identify monkeypox.

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The test for monkeypox is a PCR, run at laboratories in the same way Covid-19 tests are processed.

From when a sample reaches the lab, initial results can be available within 24 hours.

However, timing can depend on how long it takes a sample to reach a lab.

People with symptoms are encouraged to call ahead to their usual health practitioner to seek advice before visiting a medical centre or hospital if symptoms develop.

Their health practitioner whether that is at a general practice or sexual health clinic will assess their risk and decide whether a PCR test is appropriate.

People with monkeypox are asked to isolate until the scabs from lesions have fallen off.

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Terry Taylor, president of the New Zealand Institute of Medical Laboratory Science, was confident there was enough capacity to respond to monkeypox testing.

Only a small number of laboratories can process PCR tests for monkeypox but more capacity is being built ESR is collaborating with three other labs to stand up testing.

President of the New Zealand Institute of Medical Laboratory Science Terry Taylor said there was definitely capacity to test for monkeypox in Aotearoa.

We know we are not going to have to mass test, like we did with Covid-19, he said.

The PCR was very similar to the test for varicella (chickenpox), so was nothing new for labs to deal with.

Taylor was not envisaging [testing] being a major problem, because the virus was not very infectious, making it much more manageable for labs, he said.

He said labs could scale up if they needed to but he doubted they would get overrun.

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Monkeypox: What you need to know about testing for the virus in New Zealand - Stuff