ArticleThe Lancet. Microbe2023
Monitoring monkeypox virus in saliva and air samples in Spain: a cross-sectional study.
Article in The Lancet. Microbe, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 5 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
50 citing papers in PubMed, 5 syntheses or guidelines pooled it, 88 citations in OpenAlex.
- Mpox Airborne Transmission: A Systematic Review.Reviews in medical virology · 2026Pooled it
- Prevalence of mpox infection among men who have sex with men: a systematic review and meta-analysis.Infectious diseases of poverty · 2026Pooled it
- How long do bacteria, fungi, protozoa, and viruses retain their replication capacity on inanimate surfaces? A systematic review examining environmental resilience versus healthcare-associated infection risk by "fomite-borne risk assessment".Clinical microbiology reviews · 2024Pooled it
- Viral Loads in Skin Samples of Patients with Monkeypox Virus Infection: A Systematic Review and Meta-Analysis.Viruses · 2023Pooled it
- Monkeypox and oral lesions associated with its occurrence: a systematic review and meta-analysis.F1000Research · 2023Pooled it
- The globally prevalent MPXV strain exhibits high airborne and contact transmissibility in black-tailed prairie dogs.Emerging microbes & infections · 2026Article
- A single-dose inhalable rAAV-vectored vaccine against mpox virus.Cell reports. Medicine · 2026Article
- Monkeypox virus clade IIb isolate exhibits reduced virulence relative to clade IIa isolates in multiple murine models.Journal of virology · 2026Article
- Skin-to-skin household transmission of mpox from parental wrist lesion to child's gluteal region.BMJ case reports · 2026Article
- Monkeypox Virus Shedding Despite Tecovirimat Treatment in a Cohort in Toronto, Canada.The Journal of infectious diseases · 2026Article
- The expanding H5N1 avian influenza panzootic causes high mortality of skuas in Antarctica.Scientific reports · 2026Article
- From skin lesions to multi-organ involvement: Organ tropism and pathogenesis of mpox virus.iScience · 2025Review
- Decoding the mechanophysiology for inhaled onset of smallpox with model-based implications for mpox spread.Scientific reports · 2025Article
- Pathogenicity and contact transmissibility of clade IIb MPXV in African dormice.Emerging microbes & infections · 2025Article
- Evidence of Mpox clade IIb infection in primary human alveolar epithelium.Emerging microbes & infections · 2025Article
- Development and clinical application of a rapid qPCR instrument featuring three independent temperature modules and a time-based algorithm for respiratory pathogen diagnosis.Virology journal · 2025Article
- AveloMask, a novel breath aerosol collection kit for airborneJournal of clinical microbiology · 2025Article
- Best practice of gastrointestinal endoscopy during Mpox upsurge: an Indonesian Society for Digestive Endoscopy recommendation.Clinical endoscopy · 2025Review
- Shotgun metagenomics on indoor air for surveillance of respiratory, enteric, and skin viruses in a Belgian daycare setting, January to December 2022.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2025Article
- Advancing the understanding and management of Mpox: insights into epidemiology, disease pathways, prevention, and therapeutic strategies.BMC infectious diseases · 2025Review
Corrections and comments
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Authors and funding
19 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe transmission of monkeypox virus occurs through direct contact, but transmission through saliva or exhaled droplets and aerosols has not yet been investigated. We aimed to assess the presence of monkeypox virus DNA and infectious virus in saliva samples and droplets and aerosols exhaled from patients infected with monkeypox virus.
methodsWe did a cross-sectional study in patients with monkeypox confirmed by PCR who attended two health centres in Madrid, Spain. For each patient, we collected samples of saliva, exhaled droplets within a mask, and aerosols captured by air filtration through newly developed nanofiber filters. We evaluated the presence of monkeypox virus in the samples by viral DNA detection by quantitative PCR (qPCR) and isolation of infectious viruses in cell cultures.
findingsBetween May 18 and July 15, 2022, 44 patients with symptomatic monkeypox attended two health centres in Madrid and were included in the study. All were cisgender men, with a median age of 35·0 years (IQR 11·3). We identified high loads of monkeypox virus DNA by qPCR in 35 (85%) of 41 saliva samples. Infectious monkeypox virus was recovered from 22 (67%) of 33 saliva samples positive for monkeypox virus DNA. We also found a significant association between the number of affected cutaneous areas or general symptoms and the viral load present in saliva samples. Droplets exhaled from patients with monkeypox, detected inside a mask, contained monkeypox virus DNA in 32 (71%) of 45 samples, with two of the 32 positive samples showing the presence of the infectious virus. Monkeypox virus DNA in aerosols, collected from the medical consultation room, were detected in 27 (64%) of 42 samples, despite patients wearing an FFP2 mask during the visit. Infectious virus was not recovered from aerosol samples. High levels of monkeypox virus DNA were identified in aerosols collected from a hospital isolation room housing a patient with monkeypox.
interpretationThe identification of high viable monkeypox virus loads in saliva in most patients with monkeypox and the finding of monkeypox virus DNA in droplets and aerosols warrants further epidemiological studies to evaluate the potential relevance of the respiratory route of infection in the 2022 monkeypox virus outbreak.
fundingEU, Consejo Superior de Investigaciones Científicas, and Ciberinfec.
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