Orthopox Viruses

Testing site      

Alaska State Public Health Laboratory – Anchorage 

Anchorage Lab Request Form 

Diseases 

Pustular or vesicular rash illness 

Organisms 

• Variola (smallpox) 
• Non-variola orthopox 
• Vaccinia (cowpox) 
• mpox 
• camelpox 
• Borealpox (aka Alaskapox) 

Test Method 

Polymerase Chain Reaction (PCR) 

Availability

1. All clients must consult with the Section of Epidemiology for approval before testing.  
2. If approved by Epidemiology, Contact ASPHL Biothreat Team before submitting samples.  

Specimen type 

• Microscope slide touch preps 
• scabs, dried vesicular fluid 
• vesicular swabs 
• environmental samples 

Specimen collection instructions 

Contact the Section of Epidemiology immediately for consultation prior to specimen collection. 

Collect 2-4 dry lesion swab specimens as follows:  

• Vigorously swab or brush lesion with two separate sterile dry polyester or Dacron swabs per lesion (collect lesion swabs in duplicate). 
• Break off end of applicator of each swab into a 1.5- or 2-mL screw-capped tube with O-ring or place each entire swab in a separate sterile container. 
• Do not add or store in viral or universal transport media. 
• The specimens should be refrigerated or frozen within 1 hour of collection and shipped to the lab on ice packs or dry ice. 

Please also refer to CDC’s mpox guidance for collecting and handling specimens and contact ASPHL with questions about specimen submission.

Storage and transport  

• Store refrigerated 
• Ship with cool packs 
• Ambient temperature shipping is acceptable 
• Package and label as UN3373 Biological Substance, Category B. 
• Ship as quickly as possible. 

With approval, ship to: Anchorage Public Health Laboratory, ATNN: Special Pathogens Unit. 

Results  

• Orthopox virus DNA: Detected/Not Detected 
• Variola virus DNA: Detected/Not Detected 
• Non-variola virus DNA: Detected/Not Detected 

A normal result is not detected. 

Interpretation for monkeypox and borealpox testing

The Laboratory Response Network (LRN) laboratory in Anchorage tests suspect pox cases using two different polymerase chain reaction (PCR) methods, one specifically for orthopoxviruses and another for non-variola orthopoxviruses.   

• These assays detect viral DNA of orthopoxviruses using LRN methodologies for nucleic acid amplification.  
• Results should be considered in the context of clinical observations and epidemiological data for treatment.   
• Test results will be interpreted together to achieve a final result.  

Potential Outcome #1 

• Orthopoxvirus PCR is Not Detected 
• Non-variola Orthopoxvirus PCR is Not Detected 
• Interpretation is orthopoxvirus DNA has not been detected.  The patient’s condition should be re-evaluated to assess the need for dermatologic consultation and/or other diagnostic testing. 

Potential Outcome #2 

• Orthopoxvirus PCR is Detected 
• Non-variola Orthopoxvirus PCR is Not Detected 
• Interpretation is detection of orthopoxvirus DNA may be indicative of a poxvirus infection (e.g., smallpox, borealpox, or a novel orthopoxviruses). Specimen may be sent to CDC for further identification. 

Potential Outcome #3 

• Orthopoxvirus PCR is Detected 
• Non-variola Orthopoxvirus PCR is Detected 
• Interpretation is detection of non-variola orthopoxvirus DNA and orthopoxvirus DNA may be indicative of a poxvirus infection (e.g., monkeypox, vaccinia, cowpox). Specimen may be sent to CDC for further identification. 

Turnaround time  

1-2 days 

Notes   

Specimens with detectable signals of orthopox will be forwarded to the Centers for Disease Control and Prevention (CDC) in Atlanta for further characterization.   

Resources