LNS ensures public healthcare during Monkeypox outbreak while training young staff for future health crises

When numerous countries, predominantly in Europe, began observing instances of monkeypox in May 2022 without any apparent link to traditionally endemic areas, the LNS Virology and Serology Service of the Microbiology Department not only ensured the safety of Luxembourg’s population through its expertise, but also took this outbreak as an opportunity to prepare and train its young staff and scientists for the future dangerous and deadly threats.

On 21 July 2022, the WHO declared the Monkey Pox outbreak as public health emergency of global concern. As of mid-November 2022, 79411 confirmed Monkeypox cases and 50 deaths had been reported worldwide. The main reporting countries were the United States (28683), Brazil (9606), Spain (7377) and France (4102). By the end of November 2022, Luxembourg had documented 58 cases; no deaths were registered.

Understanding the Monkeypox disease

This disease is caused by the monkeypox virus, which belongs to the Orthopoxvirus genus. It is related to the variola virus, which caused smallpox before its eradication, but monkeypox symptoms are generally milder. Symptoms range from fever, headache, muscle and back pain, intense lack of energy, to a rash that usually arises in the face and limbs, but not exclusively. The rash typically initially manifests with small spots (macules) that become bumps (papules), then blisters (vesicles), then pustules and finally scabs that shed and disappear.

The disease usually takes 5 to 21 days to develop after infection, and is generally self-limited, resolving in several weeks. Diagnosis is based on PCR-testing. Typically, treatment involves primarily addressing symptoms and potentially employing antiviral medications, while prevention includes vaccination.

LNS Microbiology: results within 24h

The LNS Microbiology Department developed a diagnostic algorithm for a molecular diagnostic monkeypox test that allows reporting results within 24h after the sample reception. Laboratory confirmation of monkeypox infection is based on nucleic acid amplification testing (NAAT), using a real-time polymerase chain reaction (RT-PCR), in order to detect unique sequences of viral DNA. For epidemiological purposes, the samples are sequenced using an untargeted metagenomics approach on the Oxford Nanopore’s GridION platform and results are always communicated to the Health authorities in order to provide them with more information about how the virus spreads.

Inhouse pandemic response training

“I knew that the Monkeypox virus was not very dangerous”, states Dr Trung Nguyen Nguyen, head of Virology-Serology Service, “but the outbreak gave us a good training opportunity. We hired several new colleagues during the pandemic and since we had just experienced COVID this was a perfect occasion to train them. Faced with an epidemic you have to react very quickly.”

The service put in place a corresponding project involving the entire team in order to learn on how to manage things properly. The main focus of the project was not mainly to learn about the virus but rather about procedures to apply facing a health crisis, both in a scientific and administrative way. The outcome has been successful and satisfying for the Microbiology team: “I am glad we carried out this project”, says Dr Trung Nguyen Nguyen. “I think it was an educational and very enriching experience for all involved and helped to prepare our staff for the next dangerous biological threat.”