Background In sub-Saharan Africa, a third of people starting antiretroviral therapy and majority of patients returning to HIV-care after disengagement, present with advanced HIV disease (ADH), and are at high risk of mortality. Simplified and more affordable point-of-care (POC) diagnostics are required to increase access to prompt CD4 cell count screening for ambulatory and asymptomatic patients. The Visitect CD4 Lateral Flow Assay (LFA) is a disposable POC test, providing a visually interpreted result of above or below 200 CD4cells/mm 3. This study evaluated the diagnostic performance of this index test. Methods Consenting patients above 18years of age and eligible for CD4 testing were enrolled in Nsanje district hospital (Malawi), Gutu mission hospital (Zimbabwe) and Centre hopitalier de Kabinda (DRC). A total of 708 venous blood samples were tested in the index test and in the BD FACSCount assay (reference test method) in the laboratories (Phase 1) to determine diagnostic accuracy. A total of 433 finger-prick (FP) samples were tested on the index test at POC by clinicians (Phase 2) and a self-completed questionnaire was administered to all testers to explore usability of the index test. Results Among 708 patients, 67.2% were female and median CD4 was 297cells/mm 3. The sensitivity of the Visitect CD4 LFA using venous blood in the laboratory was 95.

The risk of infection after exposure to clade IIb mpox virus (MPXV) is unknown, and potential presymptomatic shedding of MPXV remains to be demonstrated. High-risk contacts of mpox patients were followed-up in a prospective longitudinal cohort study. Individuals reporting sexual contact, >15 min skin-to-skin contact, or living in the same household with an mpox patient were recruited in a sexual health clinic in Antwerp, Belgium. Participants kept a symptom diary, performed daily self-sampling (anorectal, genital, and saliva), and presented for weekly clinic visits for physical examination and sampling (blood and oropharyngeal). Samples were tested for MPXV by PCR. Between June 24 and July 31, 2022, 25 contacts were included, of which 12/18 (66.0%) sexual and 1/7 (14.0%) nonsexual contacts showed evidence of infection by MPXV-PCR. Six cases had typical mpox symptoms. Viral DNA was detected as early as 4 days before symptom onset in 5 of them. In 3 of these cases, replication-competent virus was demonstrated in the presymptomatic phase. These findings confirm the existence of presymptomatic shedding of replication-competent MPXV and emphasize the high risk of transmission during sexual contact. Sexual contacts of mpox cases should abstain from sex during the incubation period, irrespective of symptoms.

Epidemiological data suggest that clade IIb monkeypox virus (MPXV) is readily transmitted during sexual contact, even before symptom onset. However, presymptomatic shedding of MPXV remains to be demonstrated. Here, we prospectively followed up 25 individuals after high-risk exposure to MPXV. Daily anorectal, genital, and saliva samples and weekly blood and oropharyngeal samples were collected along with clinical information. During follow-up, 12/18 (66.0%) sexual and 1/7 (14.0%) non-sexual contacts showed evidence of MPXV infection by PCR, six of whom had low viral loads and no typical MPXV symptoms. In five out of six patients with typical symptoms, viral DNA and replication-competent virus were detected as early as four days before symptom onset. These findings emphasize the high risk of MPXV transmission during sexual contact and confirm the existence of presymptomatic viral shedding of MPXV. Sexual contacts of an MPXV-infected partner should abstain from sex irrespective of symptoms.

Although transmitted mainly through direct (sexual) contact, mpox virus (MPXV) can be detected in ambient air. We explored the use of air sampling for diagnosis or (genomic) surveillance of mpox in a sexual health clinic. For six out of six patients who were infected with MPXV, all four of our ambient air PCR tests were positive. For 14 uninfected patients, PCR was positive in three ambient air samples, albeit with higher cycle threshold (Ct) values. Genomic sequencing of samples from two positive patients showed matching sequences between air and clinical samples.

Health is the greatest asset of a state and nothing is more fundamental to a state's security than the health of its people. If individuals and groups of people are unhealthy, they cannot work, and this means that they cannot contribute to the country's economy. If they cannot contribute to the economy of the nation, the government cannot provide essential services, and this leaves the country vulnerable to diverse health security threats, with some caused by natural circumstances and others socio-economical. The initial step in bettering the global health security space is evaluating present capacity and identifying gaps in individual countries. One of the most authoritative measures of preparedness for pandemic response is the Global Health Security Index (1), which failed in predicting