ELISA Testing and the Monkeypox Epidemic

In recent months, monkeypox cases have been rising. The virus was first identified in humans in 1970, and current outbreaks are causing scientists to try and find ways to identify and track the virus in widely spread geographical areas. To date, there have been over 16,000 cases in the United States and over 45,000 cases worldwide since the outbreak began in May 2020. This zoonotic virus from the Orthopoxvirus genus has symptoms similar to smallpox, but it is clinically less severe and less contagious. The virus can travel to humans from either an infected animal or another infected human.

Animal to Human Transmissibility:

  • Blood
  • Bodily fluids
  • Mucosal lesions
  • Cutaneous lesions
  • Eating inadequately prepared infected meat

Human to Human Transmissibility:

  • Skin lesions
  • Respiratory secretions
  • Mother to fetus/infant
  • Close contact

Identifying cases of monkeypox is essential to stopping the spread, but it is proving difficult to do with new cases. Current cases of monkeypox are not presenting with expected symptoms, so cases are not being identified as quickly. This can allow infected individuals to spread the virus for a longer period of time before going into quarantine. Because of this, diagnosing monkeypox must rely more heavily on laboratory tests instead of symptom presentation.

One method showing promise in monkeypox diagnosis is enzyme-linked immunosorbent assay (ELISA) testing. ELISA test kits are used to detect the presence or absence of antigens, antibodies, and proteins in biological samples, like cell lysates, serum, and other fluids. Target antigens are immobilized on a microplate and then put into contact with an antibody linked to a reporter enzyme. The reporter enzyme’s activity is measured and used for the detection of the antigen. A critical element of ELISA tests’ success is the highly specific antigen-antibody interaction.

In practice, this application can be seen in a case study from July 2022. An ELISA test aided in diagnosing a patient with perianal and ocular vesicles with monkeypox. Mucosal vesicles are not entirely uncommon with monkeypox, but the connection may be overlooked due to the infrequency of occurrence. ELISA tests were used to detect HIV antibodies and Hepatitis C virus antibodies, but both tests were negative. These two viruses were eliminated as potential causes, allowing the medical team to continue their search and ultimately diagnose monkeypox.

Currently, ELISA testing has broad applications that give it the potential to help detect, track, and respond to the monkeypox pandemic. The high accuracy and affordability of ELISA tests can identify positive cases and also track disease progression from the quality of antibodies in a sample. The best way to reduce a viral outbreak is to prevent viral spread. ELISA testing creates an effective avenue for containing virus progression through identification, regardless of clinical symptoms.

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