New Zealand has recorded two unlinked cases of monkeypox this week and authorities say there is no evidence of community transmission.
Monkeypox is endemic in parts of central and western Africa, but an outbreak was confirmed in May, spreading to more than 50 countries with 9,624 cases detected as of July 11.
So far, two tests have been carried out in New Zealand. The Institute of Environmental Science and Research (ESR) has 500 tests in stock and there will likely be more stock in other labs, officials said.
So how does the monkeypox test work? How long does it take, who needs to get tested and do we have the capacity?
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How is monkeypox transmitted and what are the symptoms?
The first symptoms of monkeypox are usually headache, acute onset of fever (>38.0°C), chills, swollen lymph nodes, muscle and body aches, back pain, and fatigue.
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 genitals.
The monkeypox rash typically progresses through four stages – macular (flat), papular (raised), vesicular (raised and filled with clear fluid), to pustular (raised and filled with opaque fluid) – before crusting over and disappearing .
To be infected, you must be in close contact (usually skin-to-skin or shared respiratory droplets) with a case while it is infectious.
Who should be tested?
At this point, close contacts are advised to monitor for symptoms for three weeks and to isolate if symptoms develop. They would only undergo a PCR test if a rash developed, the health ministry said.
The incubation period (from infection to onset of symptoms) is usually 6-13 days but can range from 5-21 days.
Close contacts are not required to strictly quarantine, but are advised to avoid high-risk environments such as healthcare, daycare and aged care facilities, as well as gatherings at indoors such as 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 greater risk of infection, such as infants, the elderly, and immunocompromised people.
How is a sample taken?
While swabbing your nose or throat for Covid-19, the recommended specimen type for monkeypox is skin lesion material.
This involves taking swabs from the surface of a lesion and/or exudate (wound fluid), from the roofs of more than one lesion, or from the crusts of the lesion – from the rash itself.
How is the test going?
Confirming someone has monkeypox is similar to confirming Covid-19 infection via a PCR test.
The 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 different concentrations, which indicates whether a result is positive, negative, or inconclusive in identifying monkeypox.
How long does it take?
From the moment a sample arrives at the lab, the first results can be available within 24 hours.
However, the turnaround time may depend on how long it takes for a sample to reach a lab.
How to access the tests?
People with symptoms are encouraged to call their regular GP ahead of time for advice before going to a medical center or hospital if symptoms develop.
Their healthcare provider – whether a GP practice or a sexual health clinic – will assess their risk and decide if a PCR test is appropriate.
People with monkeypox are advised to self-isolate until the scabs from the lesions have fallen off.
Do we have the capacity?
Only “a small number” of labs can process PCR testing for monkeypox, but greater capacity is being built – ESR is working with three other labs to set up testing.
The president of the New Zealand Institute of Medical Laboratory Sciences, Terry Taylor, said there was certainly the capacity to test for monkeypox in Aotearoa.
“We know we’re not going to have to do mass testing, like we did with Covid-19,” he said.
PCR was very similar to the varicella (varicella) test, so there was nothing new for labs to deal with.
Taylor “did not consider [testing] being a major problem” because the virus was not very contagious, making it “much more manageable” for labs, he said.
He said the labs could expand if they needed to, but he doubted they were “overwhelmed”.