ArticleThe Journal of infectious diseases2026
Monkeypox Virus Shedding Despite Tecovirimat Treatment in a Cohort in Toronto, Canada.
Article in The Journal of infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTecovirimat (TPOXX) is an antiviral authorized for the treatment of mpox infections in Canada, but recent clinical trials found it has no impact on symptom duration.
methodsWe conducted a prospective cohort study of individuals diagnosed with mpox in Toronto, Canada. Skin lesion swabs were collected weekly to quantify infectious monkeypox virus (MPXV) shedding through cell culture. The presence of antiviral resistance mutations was assessed by PCR and sequencing the F13L gene.
resultsAmong 17 participants, 9 received tecovirimat, with a median initiation time of 14 days post-symptom onset. Infectious MPXV was detected in 31% (17/55) of lesion swabs from tecovirimat-treated participants and 32% (20/62) from untreated individuals. Shedding kinetics were similar between groups, with persistent infectious virus detected in several participants beyond 2 weeks of symptoms. Despite more than 7 days after tecovirimat initiation, 4 treated participants still shed viable virus in at least 1 sampled lesion, including up to 15 days after tecovirimat initiation. No known resistance mutations were identified in viral sequences from a subset of lesion swabs from both treated and untreated individuals, suggesting that tecovirimat resistance mutations were not widely circulating in Toronto during the 2022 outbreak.
conclusionsOur findings suggest that tecovirimat does not significantly impact the duration of infectious MPXV shedding from skin lesions, aligning with recent randomized trial results. These findings highlight the need for alternative antiviral strategies and continued genomic surveillance to monitor resistance emergence.
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