Serological methods for the detection of antibodies against Monkeypox
virus applicable for laboratories with different biosafety levels
Abstract
The monkeypox virus (MPXV) outbreak in 2022 has renewed interest in the
detection of antibodies against orthopox viruses (OPXV) and MPXV, as
serological methods can aid diagnostics and are key to epidemiological
studies. Here three complementary serological methods are described with
different strengths to aid the development and evaluation of in-house
assays: An immunofluorescence assay (IFA) for specific detection of IgG
and IgM, an enzyme-linked immunosorbent assay (ELISA) for higher sample
throughput to aid epidemiological studies and a neutralization test (NT)
to detect virus neutralising antibodies. As implementation of
MPXV-specific diagnostics is often hampered by the requirement for a
dedicated biosafety level 3 laboratory (BSL-3), the focus is on
biosafety aspects to facilitate safe testing also under BSL-2
conditions. To this aim, IFA and NT titres of sera are compared after
MPXV or cowpox virus infection or vaccinia virus immunization by using
both homologous and heterologous antigens. Because of a large degree of
cross-reactivity, vaccinia virus could be used as a less virulent
alternative to MPXV, as VACV can be handled under BSL-2 conditions.
Furthermore, an inactivation method to remove potentially infectious
virus particles from viraemic sera without compromising antibody
detection was developed. Although the existing immunological
cross-reactivity between OPXV prevents species differentiation by
general serological methods, it also provides an opportunity for the
interchangeable usage of different OPXV species in serological assays,
enabling MPXV serology outside of BSL-3 facilities.