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Investigação laboratorial do vírus monkeypox e avaliação das medidas de biossegurança nos laboratórios em Portugal
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O vírus monkeypox (MPXV), pertencente ao género Orthopoxvirus (OPXV), emergiu como um agente patogénico de relevância crescente devido à sua capacidade de transmissão sustentada fora das regiões endémicas e ao declínio da imunidade populacional após a interrupção da vacinação contra a varíola. Na sequência do surto multinacional de 2022 e da continuidade de novas cadeias de transmissão nos anos seguintes, tornou-se essencial reforçar a investigação virológica, epidemiológica e serológica, bem como avaliar de forma sistemática as condições de biossegurança e bioproteção nos laboratórios de referência.
Este trabalho teve como objetivos: analisar os aspetos epidemiológicos, virológicos e genómicos dos casos suspeitos e confirmados durante o terceiro surto de mpox registado em Portugal; avaliar o potencial de diagnóstico clínico incorreto com varicela durante o primeiro surto; determinar a resposta serológica IgG anti-OPXV em indivíduos com e sem confirmação laboratorial de mpox; e caracterizar as práticas de biossegurança e bioprotecção em laboratórios portugueses, incluindo laboratórios BSL-3.
Os resultados revelaram a circulação de múltiplas sublinhagens do clade IIb, demonstrando que o surto resultou de várias introduções independentes. Verificou-se um predomínio de casos em homens adultos jovens e maior positividade em exsudados de lesão. A investigação do diagnóstico diferencial mostrou que uma proporção significativa das amostras inicialmente suspeitas correspondia a infeções por VZV. A análise
serológica evidenciou variação dos títulos de IgG entre grupos etários e clínicos, destacando a influência da imunidade prévia à varíola nos indivíduos mais velhos. A avaliação da biossegurança e bioproteção identificou níveis heterogéneos de maturidade e áreas prioritárias de melhoria, especialmente nos sistemas de gestão e nas práticas de resposta a emergências.
Globalmente, este estudo contribui para o reforço da vigilância laboratorial e epidemiológica da mpox em Portugal, fornecendo evidência científica crucial para a preparação e resposta a futuras emergências biológicas. Os resultados sublinham ainda a importância estratégica da biossegurança e bioproteção na manipulação de agentes emergentes e na mitigação dos riscos associados.
The monkeypox virus (MPXV), a member of the genus Orthopoxvirus (OPXV), has emerged as a pathogen of increasing global significance due to its ability to sustain transmission outside endemic regions and the progressive decline in population immunity following the cessation of smallpox vaccination. Following the multinational outbreak in 2022, and with new transmission chains persisting in subsequent years, it became essential to strengthen virological, epidemiological and serological investigations, as well as to systematically evaluate biosafety and biosecurity capacities in reference laboratories. This study aimed to: analyse the epidemiological, virological and genomic characteristics of suspected and confirmed cases during the third mpox outbreak recorded in Portugal; assess the potential for clinical misdiagnosis with varicella during the first outbreak; determine the IgG anti-OPXV serological response in individuals with and without laboratory confirmation of mpox; and evaluate biosafety and biosecurity practices in Portuguese laboratories, including BSL-3 facilities. The results revealed the circulation of multiple sublineages within clade IIb, indicating that the outbreak was driven by several independent introductions. A predominance of cases in young adult men was observed, along with higher molecular positivity in lesion swabs. Differential diagnosis analysis showed that a substantial proportion of cases initially suspected to be mpox corresponded to VZV infections. Serological assessment demonstrated variation in IgG titres across age groups and clinical categories, with higher responses in older individuals, consistent with immunity derived from historic smallpox vaccination. The evaluation of biosafety and biosecurity practices revealed heterogeneous levels of maturity and highlighted priority areas for improvement, particularly in management systems and emergency preparedness. Overall, this study strengthens laboratory and epidemiological surveillance of mpox in Portugal and provides essential scientific evidence to support preparedness and response to future biological emergencies. The findings also underscore the strategic importance of biosafety and biosecurity in handling emerging pathogens and mitigating associated risks.
The monkeypox virus (MPXV), a member of the genus Orthopoxvirus (OPXV), has emerged as a pathogen of increasing global significance due to its ability to sustain transmission outside endemic regions and the progressive decline in population immunity following the cessation of smallpox vaccination. Following the multinational outbreak in 2022, and with new transmission chains persisting in subsequent years, it became essential to strengthen virological, epidemiological and serological investigations, as well as to systematically evaluate biosafety and biosecurity capacities in reference laboratories. This study aimed to: analyse the epidemiological, virological and genomic characteristics of suspected and confirmed cases during the third mpox outbreak recorded in Portugal; assess the potential for clinical misdiagnosis with varicella during the first outbreak; determine the IgG anti-OPXV serological response in individuals with and without laboratory confirmation of mpox; and evaluate biosafety and biosecurity practices in Portuguese laboratories, including BSL-3 facilities. The results revealed the circulation of multiple sublineages within clade IIb, indicating that the outbreak was driven by several independent introductions. A predominance of cases in young adult men was observed, along with higher molecular positivity in lesion swabs. Differential diagnosis analysis showed that a substantial proportion of cases initially suspected to be mpox corresponded to VZV infections. Serological assessment demonstrated variation in IgG titres across age groups and clinical categories, with higher responses in older individuals, consistent with immunity derived from historic smallpox vaccination. The evaluation of biosafety and biosecurity practices revealed heterogeneous levels of maturity and highlighted priority areas for improvement, particularly in management systems and emergency preparedness. Overall, this study strengthens laboratory and epidemiological surveillance of mpox in Portugal and provides essential scientific evidence to support preparedness and response to future biological emergencies. The findings also underscore the strategic importance of biosafety and biosecurity in handling emerging pathogens and mitigating associated risks.
Descrição
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Palavras-chave
Vírus monkeypox Orthopoxvirus Vigilância genómica Diagnóstico diferencial Anticorpos IgG Biossegurança Bioproteção Laboratórios BSL-3