A retrospective genomic characterisation of the 2022 mpox outbreak in Belgium, and in vitro assessment of three antiviral compoundsResearch in context
Tony Wawina-Bokalanga,
Bert Vanmechelen,
Anne-Sophie Logist,
Mandy Bloemen,
Lies Laenen,
Sébastien Bontems,
Marie-Pierre Hayette,
Cécile Meex,
Christelle Meuris,
Catherine Orban,
Emmanuel André,
Robert Snoeck,
Guy Baele,
Samuel L. Hong,
Graciela Andrei,
Piet Maes
Affiliations
Tony Wawina-Bokalanga
Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory of Clinical and Epidemiological Virology, 3000, Leuven, Belgium; Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo; Département de Biologie Médicale, Service de Microbiologie, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo; Corresponding author. Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory of Clinical and Epidemiological Virology, 3000, Leuven, Belgium.
Bert Vanmechelen
Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory of Clinical and Epidemiological Virology, 3000, Leuven, Belgium
Anne-Sophie Logist
Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory of Clinical and Epidemiological Virology, 3000, Leuven, Belgium
Mandy Bloemen
Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory of Clinical and Epidemiological Virology, 3000, Leuven, Belgium
Lies Laenen
Department of Laboratory Medicine, University Hospitals Leuven, 3000, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Laboratory of Clinical Microbiology, 3000, Leuven, Belgium
Sébastien Bontems
Department of Clinical Microbiology, University Hospital of Liege, 4000, Liege, Belgium
Marie-Pierre Hayette
Department of Clinical Microbiology, University Hospital of Liege, 4000, Liege, Belgium
Cécile Meex
Department of Clinical Microbiology, University Hospital of Liege, 4000, Liege, Belgium
Christelle Meuris
Department of Infectious Diseases and General Internal Medicine, University Hospital of Liege, 4000, Liege, Belgium
Catherine Orban
Department of Infectious Diseases and General Internal Medicine, University Hospital of Liege, 4000, Liege, Belgium
Emmanuel André
Department of Laboratory Medicine, University Hospitals Leuven, 3000, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Laboratory of Clinical Microbiology, 3000, Leuven, Belgium
Robert Snoeck
Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory of Virology and Chemotherapy, 3000, Leuven, Belgium
Guy Baele
Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory of Clinical and Epidemiological Virology, 3000, Leuven, Belgium
Samuel L. Hong
Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory of Clinical and Epidemiological Virology, 3000, Leuven, Belgium
Graciela Andrei
Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory of Virology and Chemotherapy, 3000, Leuven, Belgium
Piet Maes
Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory of Clinical and Epidemiological Virology, 3000, Leuven, Belgium; Corresponding author.
Summary: Background: Since the beginning of May 2022, cases of mpox have been reported in several European and American countries where the disease is nonendemic. We performed a retrospective genomic characterisation of the 2022 mpox outbreak in Belgium, and assessed the in vitro sensitivity of three antiviral compounds to a monkeypox virus (MPXV) strain from the 2022 outbreak. Methods: We sequenced the complete genomes of MPXV isolated from skin-, throat-, anorectal- and genital swab samples using the Oxford Nanopore Technologies (ONT) GridION. We subsequently analysed high-quality complete MPXV genomes and conducted a genomic analysis of MPXV complete genomes from this study with all other complete MPXV genomes available on GISAID up to October 28th, 2022. The in vitro activity of tecovirimat, brincidofovir, and cidofovir was also tested in human and monkey cell lines. Findings: We produced 248 complete MPXV genomes. Phylogenetic analysis of the complete MPXV genomes revealed that they all belong to MPXV Clade IIb B.1. Surprisingly, through phylogeographic analysis we identified a minimum number of 79 introduction events into Belgium, along with sustained local transmission. We also demonstrated the superior in vitro efficacy and selectivity of tecovirimat to the 2022 MPXV clinical strain. Interpretation: The number of sequences provides sufficient information about the MPXV lineages that were circulating in Belgium. The 2022 mpox outbreak, in Belgium, was mainly characterised by many introduction events that were promptly contained and resulted in limited human-to-human transmission of MPXV. The in vitro efficacy of antivirals against a 2022 MPXV Belgian strain highlights the potent activity and specificity of tecovirimat and its ability to prevent the formation of the extracellular enveloped viruses. Funding: None.
