Cordeiro, RitaPelerito, Anade Carvalho, Isabel LopesLopo, SílviaNeves, RaquelRocha, RaquelPalminha, PaulaVerdasca, NunoPalhinhas, CláudiaBorrego, Maria JoséManita, CarlaFerreira, IdalinaBettencourt, CéliaVieira, PatríciaSilva, SóniaÁgua-Doce, IvoneRoque, CarlaCordeiro, DoraBrondani, GreiceSantos, João AlmeidaMartins, SusanaRodrigues, IreneRibeiro, CarlosNúncio, Maria SofiaGomes, João PauloBatista, Fernando da Conceição2025-03-172025-03-172024-12J Med Virol. 2024 Dec;96(12):e70104. doi: 10.1002/jmv.701040146-6615http://hdl.handle.net/10400.18/10442Mpox is a zoonotic disease caused by the Monkeypox virus (MPXV), and since May 2022, tens of thousands of cases have been reported in non-endemic countries. We aimed to evaluate the suitability of different sample types for mpox diagnostic and assess the temporal dynamics of viral load. We evaluated 1914 samples from 953 laboratory-confirmed cases. The positivity rate was higher for lesion (91.3%) and rectal swabs (86.1%) when compared with oropharyngeal swabs (69.5%) and urines (41.2%), indicating higher viral loads for the former. Supporting this, lesion and rectal swabs showed lower median PCR C values (C = 23 and C = 24), compared to oropharyngeal swabs and urines (C = 31). Stable MPXV loads were observed in swabs from lesions up to 30 days after symptoms onset, contrasting with a considerable decrease in viral load in rectal and oropharyngeal swabs. Overall, these results point to lesion swabs as the most suitable samples for detecting MPXV in the 2022-2023 multicountry outbreak and show comparable accuracy to rectal swabs up to 8 days after symptoms onset. These findings, together with the observation that about 5% of patients were diagnosed through oropharyngeal swabs while having negative lesions, suggest that multisite testing should be performed to increase diagnostic sensitivity.engCt ValuesMonkeypox VirusClinical SamplesPositive RateViral ClearanceViral LoadPortugalInfecções Sistémicas e Zoonosesresearch article10.1002/jmv.7010439654358