Serological evidence uncovers undocumented mpox exposure in febrile patients in Nigeria

Résumé

Introduction The monkeypox virus (MPXV) has become a global health threat, with rising cases reported globally. Since its re-emergence in 2017, Nigeria has experienced a sustained outbreak, underscoring the critical need for robust surveillance mechanisms to identify transmission dynamics. Despite this urgency, data regarding MPXV seroprevalence among patients seeking medical care in Nigeria remains scarce. MPXV may be underreported because its clinical symptoms overlap with those of other common causes of fever. Methods We assess MPXV seroprevalence among febrile patients across multiple Nigerian healthcare facilities using A35R and A29L antigens in a Luminex bead-based immunoassay. The study enrolled 245 febrile individuals in Ondo, Benue, Plateau, and Osun States from June 2023 to July 2024. Plasma samples were analyzed for antibodies targeting MPXV A35R and A29L antigens. A manual-based 3-standard-deviation threshold method and an R-based SeroNIST analytical framework were used. Statistical analyses assessed assay reliability and identified potential risk factors associated with MPXV exposure. Results and discussion Both antigens showed comparable exposure patterns ( p = 0.297). The 3SDV threshold method identified seroprevalence rates of 47.4% for A35R and 40.4% for A29L. The SeroNIST approach yielded estimates of 30.51% and 21.17% for A35R and A29L, respectively. Participants ( n =62; 25.31%) showed reactivity to both antigens. Bivariate analyses revealed that only the state of residence significantly influenced serostatus for both antigens, whereas sex, occupation, and marital status significantly affected A29L serostatus only. Multivariable regression indicated that none of the variables were significantly associated with A35R seropositivity; however, participants from Ondo showed a higher, but non-significant, odds of seropositivity. For A29L, health workers, males, and participants from Osun had significantly lower odds of seropositivity, while those aged 26–36 had higher non-significant odds. These results confirm considerable MPXV exposure among febrile patients and call for longitudinal and region-specific studies to unravel temporal and geographic trends in its seroprevalence in Nigeria.

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