When It Comes to Monkeypox Testing, Clinical Laboratories Should Be Aware of Five Significant Developments

There are reports of phlebotomists refusing to draw monkeypox blood samples and social stigma surrounding the disease can affect who gets a medical laboratory test

Cases of monkeypox are increasing in the US—14,115 as of Aug. 19, up 1,400 from the prior week—and clinical laboratories around the country are bracing for a potential increase in monkeypox testing orders.

Several factors, however, are affecting the testing. Chief among them:

  • Lab workers refusing to take blood draws from potential monkeypox patients, and
  • Community clinics in some cities having to delay other care to deal with an onslaught of monkeypox test orders.

Here are five trends clinical laboratory leaders should be aware of that are influencing the state of monkeypox testing in the country.

Trend 1: Some Phlebotomists Refuse to Draw Possible Monkeypox Specimens

CNN reported that phlebotomists at two of the largest commercial laboratories—Labcorp and Quest Diagnostics—were either refusing or being told not to draw blood samples from suspected monkeypox patients.

“Labcorp and Quest don’t dispute that, in many cases, their phlebotomists are not taking blood from possible monkeypox patients,” according to CNN. “What remains unclear, after company statements and follow-ups from CNN, is whether the phlebotomists are refusing on their own to take blood or if it is the company policy that prevents them. The two testing giants say they’re reviewing their safety policies and procedures for their employees.”

In “Medical Laboratories Respond to Monkeypox Outbreak Using CDC-Developed Diagnostic Test,” Dark Daily noted that skin lesion swabbing, such as that necessary to perform the Orthopoxvirus PCR test, is the preferred method to check for monkeypox because of higher viral counts in the lesions. However, physicians may order follow-up blood tests for confirmed monkeypox patients, and suspected patients may need bloodwork as part of other routine care.

In an update posted on its website, Quest noted it has been testing swab specimens of skin lesions for monkeypox, but those swabs are performed by providers and not Quest. However, the company was also preparing to take blood draws of possible monkeypox patients in its patient service centers.

“Given that monkeypox has been declared a national public health emergency and the most recent CDC guidance, we are now implementing procedures to safely enable patients with suspected or confirmed monkeypox infection into our patient service sites for phlebotomy blood draws and other non-swab specimen collections,” Quest stated. “This approach will enable patients with suspected or confirmed monkeypox infections to receive additional testing they may need.”

Trend 2: Guidance Is Available to Help Lab Workers Avoid Monkeypox Infection

The CDC has posted guidance to maintain infection control around suspected monkeypox specimens. Among the steps noted by the agency:

  • Lesion specimens from patients suspected of having monkeypox will carry the highest quantity of the virus. When possible, lab workers that have a smallpox vaccination from within the last three years should handle these specimens. Smallpox vaccination also protects from monkeypox in many cases. Unvaccinated workers who test suspected monkeypox specimens need to take extra precautions, such as wearing a buttoned lab coat, gloves, and face protection, and avoiding splashes, the CDC stated.
  • Blood specimens draw from suspected monkeypox patients will have a low quantity of the virus. Lab workers testing these specimens do not need to be vaccinated for monkeypox, but standard precautions should be followed.
  • Before using automated testing platforms with suspected monkeypox specimens, labs should conduct a risk assessment to identify potential hazards.

Trend 3: Monkeypox Testing Gains an Early Social Stigma

Some people who need to be tested for monkeypox may be hesitant to seek out a medical laboratory or patient service center because of a stigma being attached to the disease.

Although it does not match the early hysteria associated with HIV infections in the 1980s—in a 1987 poll, 60% of respondents said AIDS patients should carry a card identifying them as such, Gallup noted—there have been clear instances where people and agencies have associated monkeypox infection with men having sex with other men.

“The focus for all countries must be engaging and empowering communities of men who have sex with men to reduce the risk of infection and onward transmission, to provide care for those infected, and to safeguard human rights and dignity,” Tedros Adhanom Ghebreyesus, PhD, the Director-General at the World Health Organization, said in a July 27 media briefing.

Ghebreyesus added that while 98% of monkeypox infections have been among men who have sex with men, anyone can get the disease, including children.

Tedros Adhanom Ghebreyesus, PhD

“Stigma and discrimination can be as dangerous as any virus, and can fuel the outbreak,” said Tedros Adhanom Ghebreyesus, PhD (above), Director-General at the World Health Organization (WHO), in a media briefing. Clinical laboratories would be wise to prepare for a marked increase in demand for monkeypox testing. (Photo Copyright: WHO/Christopher Black.)

“Men who have sex with men have been hit the hardest by monkeypox to date, but LGBTQ+ health advocates say improper messaging risks branding monkeypox as a ‘gay disease,’ eroding effective preventive measures and allowing the virus to spread,” Bloomberg Law reported.

Further, while many Americans are aware of monkeypox, a significant number don’t know enough about the disease, according to survey results from the Annenberg Public Policy Center of the University of Pennsylvania.

For example, 66% of respondents either were not sure or did not believe there is a vaccine for monkeypox.

Trend 4: Workers Who Refuse to Test Patients for Monkeypox Face Possible Backlash

Some medical professionals have raised concerns about healthcare workers being unwilling to test monkeypox patients.

“This is absolutely inexcusable. It’s a grave dereliction of duty,” David Harvey, Executive Director of the National Coalition of STD Directors, told CNN. The group represents sexually transmitted disease (STD) directors at public health departments in the US.

“For every single patient that walks [through] your door, you use universal precautions because every disease doesn’t have a phenotype or outward appearance, so you have to treat everyone exactly the same,” Garfield Clunie, MD, president of the National Medical Association and Assistant Professor of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, told Bloomberg Law. “You can’t treat someone differently because of their sexual orientation, or race, or gender, or for any other reason.”

Trend 5: Public Clinics Show Early Signs of Monkeypox Testing Pressure

A survey of 80 public health departments conducted by the National Coalition of STD Directors indicated that some sites may already be getting overwhelmed by demand for monkeypox testing.

According to the survey results, 79% of public health clinics saw an increased demand for monkeypox testing over the past four weeks. In a troubling aspect, 28% of clinics said they could not meet testing demand if it increases.

Further, 22% of clinics have reduced screenings for other STDs to prioritize monkeypox testing. Such moves likely delay patients from receiving other care they need.

Clinical laboratories may want to take note of the survey findings. The pressure public health clinics currently face could be a precursor to similar problems at labs if demand for monkeypox testing grows.

Scott Wallask

Related Information:

Some Lab Techs Refuse to Take Blood from Possible Monkeypox Patients, Raising Concerns about Stigma and Testing Delays

NCSD Releases Second Survey of Clinic Capacity in Monkeypox Response

AIDS Echoes in Monkeypox Messages Worry LGBTQ Health Advocates

WHO Director-General’s Opening Remarks at the COVID-19 Media Briefing—27 July 2022

CDC: Laboratory Procedures and Biosafety Guidelines

CDC: Monkeypox and Smallpox Vaccine Guidance

Gallup Vault: Fear and Anxiety During the 1980s AIDS Crisis

Quest Diagnostics Media Statement about COVID-19 and Monkeypox Testing

Medical Laboratories Respond to Monkeypox Outbreak Using CDC-Developed Diagnostic Test

Labcorp monkeypox testing information

WHO fact sheet on monkeypox

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