How to Collect an Mpox Specimen for Diagnostic Testing
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Specimen Collection and Laboratory Practices Key to Mpox Testing
This post is based on a course module and is designed as a reference on how to collect an appropriate specimen for mpox virus diagnostic testing. For guided visuals and detailed images on the process, please use the course module.
Renaming to Mpox
NETEC is in the process of updating its web pages with the term “mpox” to reduce stigma and other issues associated with prior terminology. This change is aligned with the World Health Organization decision.
Equipment and Considerations
Disease Progression
Mpox is a disease that is caused by infection with the Mpox virus. Mpox virus belongs to the Orthopoxvirus genus in the family Poxviridae. The Orthopoxvirus genus also includes variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus.
Lesions typically begin to develop simultaneously and evolve together on any given part of the body. The evolution of lesions progresses from macular to papular to vesicular and finally to pustular before scabbing over and resolving.
Contact Your Health Department
If mpox is suspected, contact your state or local health department prior to collection.
Specimen Types
- Swabs of lesions or lesion material are currently the specimen of choice.
- Check with your local Health Department (or designated testing facility) on currently acceptable specimen types.
Acceptable Swabs
- Synthetic tipped swaps (polyester, nylon, Dacron, etc.) with plastic, wood, or aluminum shafts are recommended.
- Cotton tipped swabs are NOT RECOMMENDED.
- Swabs in media designated for bacterial preservation may cause PCR inhibition and are NOT RECOMMENDED.
Transport Media
Dry swabs are currently preferred, however some labs may accept swabs in viral transport media. Check with your testing laboratory for acceptable media types.
Personal Protective Equipment (PPE)
Before beginning the collection process, ensure that you have the appropriate PPE for the task.
The minimum recommendation for collecting MPX specimens is:
- N95 respirator
- Eye protection (face shield or goggles)
- Gown
- Gloves (follow your institution’s protocols, extended and/or double gloves may be preferred depending on workflow but are not required)
Mpox Specimen Collection
Swabbing the Lesions
- At least two different lesions should be sampled, preferably from different locations.
- Collect two swabs from each lesion.
Inserting the Swab into a Sterile Container
- If necessary, break the swab’s shaft to fit into the sterile container.
- If using a wire shaft swab, carefully bend the wire to fit inside the sterile container.
- After securing the lid, wipe down the container with an EPA-approved disinfectant wipe.
Breaking the Swab’s Shaft
Labeling
Clearly label each specimen container with the appropriate patient information and include the specimen type as well as the site the specimen was taken from (for example, left thumb, right cheek, etc).
Labels should include:
- Patient’s name
- Patient’s date of birth
- Collection date
- Collection site
- Facility protocols may require additional information to be added to the labels
Packaging: Bagging the Labeled Specimen
Before starting the packaging process, perform hand hygiene and change gloves. Clean and disinfect the working surface.
Step 1: Carefully place the labeled specimen into an appropriate specimen bag.
Step 2: The specimen container should be positioned at the bottom of the bag. Starting at the bottom, slowly roll up the bag to remove as much air as possible.
Step 3: Continue to roll up the bag.
Step 4: Seal the first bag while it is still rolled up.
Ready for Shipping
- Refrigerate (2-8C) or Freeze (-20C) within 1 hour of collection. Samples should be frozen if there is any delay in shipping.
- Laboratory testing has indicated that the current mpox outbreak is associated with the West African clade of mpox virus. The U.S. government does not consider the West African clade of mpox virus as meeting the definition of Category A infectious substance under the Hazardous Materials Regulations (HMR). Therefore, specimens and material suspected or confirmed to contain the West African clade of mpox virus can be shipped as UN 3373 Biological Substance, Category B.
- Follow current local, state, and DOT regulations on packaging and shipping specimens.
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