Transmission of monkeypox virus through the saliva and air that need careful management
Xi Yang, MD,a,b,c
Qian Liao, DDS,b,d
Wei Liu, MD,
b and
Feng Xu, PhDe
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Dear Editor,
The ongoing outbreak of monkeypox is believed to be predominantly transmitted through direct contact with lesions or infected bodily fluids, with possible involvement of fomites and large respiratory droplets
1–
5.
We read with great interest three letters to the editor entitled “Salivary transmission of monkeypox virus – a potential possibility that needs careful management?,” “Can monkeypox virus be transmitted through the air?,” and “Should not airborne transmission be ignored in the 2022 monkeypox outbreak?” recently published in the
International Journal of Surgery 6–
8.
Due to the lack of direct evidence in the letters, the authors only put forward the hypothesis that the monkeypox virus (MPXV) can be transmitted through oral saliva and air, respectively
6–
8. In fact, the detection of MPXV DNA in the saliva was reported a little earlier in the previous studies
9–
11, before the time (6 September 2022) of the letter submitted by Ganapathy
et al. 6 Furthermore, the evidence on transmission of MPXV through the saliva and air are newly reported in the literature
12,
13.
The current correspondence attempts to conduct a compact review of PubMed and Web of Science online databases of studies reporting the evidence on the detection of MPXV in saliva and air, so as to improve knowledge on the transmission and management of the virus.
As for salivary transmission of MPXV, there are 32 cases studied in four existing studies (Table
(Table1).1).
Of these, the virus DNA in saliva samples of 30 cases was positively detected. The high concordance (93.75%) of MPXV infection between saliva and skin lesion, indicating that saliva-based tests may be a viable method for MPXV DNA detection. Ganapathy
et al. 6 stated that medical literature demonstrating monkeypox in saliva is unclear.
Nowadays, MPXV in the saliva is demonstrated and salivary transmission should be substantial.
Compared with MPXV detection sampling from anatomical sites, salivary diagnostics has some advantages, such as noninvasive, easy collection, even self-collection, less exposure of healthcare workers and risk of cross-infection, no need of specific instruments.
More importantly, the positive prevalence (93.75%) and viral load (median
C t, 27) of MPXV DNA test in saliva (Table
(Table1)1) was reported to be higher than those in other bodily fluids, such as semen, blood, urine
14. In addition to the diagnosis itself, the research on molecular feature of the saliva containing cytokines, chemokines, immunoglobulins, proteomic, and metabolomics at different times of disease course in cases of monkeypox will help understanding molecular changes of transmissible viral form.