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Genomic evidence of varicella-zoster virus among Mpox-suspected cases in Ethiopia during the 2022 Mpox multi-country outbreak

Tayachew, Adamu ; Kebede, Nigatu ; Alayu, Mikias ; Onywera, Harris ; Kanyerezi, Stephen ; Agune, Adimikew ; Shure, Wolde ; Gebeyehu, Ayele ; Berkesa, Tsegaye and Getu, Melak , et al. (2026) In Scientific Reports 16(1).
Abstract

Chickenpox is a highly contagious viral infection caused by varicella-zoster virus (VZV) whose clinical manifestations mimic mpox posing challenges for diagnosis without laboratory confirmation. Here, we investigated VZV among the mpox-suspected cases, May to October 2022, in Ethiopia. Samples were collected from 202 mpox-suspected cases in 11 of Ethiopia’s 14 regions and screened for mpox virus by real-time polymerase chain reaction (RT-PCR). Then, differential testing of other selected orthopoxviruses, VZV and herpes simplex virus (HSV) were conducted for 133 randomly selected samples. Whole-genome sequencing (WGS) and downstream analysis was performed on 8 VZV-positive samples. Descriptive statistics were used to summarize... (More)

Chickenpox is a highly contagious viral infection caused by varicella-zoster virus (VZV) whose clinical manifestations mimic mpox posing challenges for diagnosis without laboratory confirmation. Here, we investigated VZV among the mpox-suspected cases, May to October 2022, in Ethiopia. Samples were collected from 202 mpox-suspected cases in 11 of Ethiopia’s 14 regions and screened for mpox virus by real-time polymerase chain reaction (RT-PCR). Then, differential testing of other selected orthopoxviruses, VZV and herpes simplex virus (HSV) were conducted for 133 randomly selected samples. Whole-genome sequencing (WGS) and downstream analysis was performed on 8 VZV-positive samples. Descriptive statistics were used to summarize epidemiological and clinical data. All the 202 enrolled cases tested negative for mpox. Of these, 133 samples were tested for VZV, and 107 (80.5%, 95% CI: 72.9% – 86.3%) turned positive but remained negative for HSV and other tested orthopoxviruses. At least one VZV-positive case was reported in each region sampled. Half (49.6%) of the cases were hospitalized, with no fatalities. The sequences were clustered primarily in Clade 5 (62.5%, 5) followed by Clade 3 (25.0%, 2) and Clade 1 (12.5%, 1). This investigation confirmed VZV as the predominant causative agent among mpox-suspected cases. To our knowledge, this represents the first clade-level genomic characterization of VZV from Ethiopia, revealing circulation of multiple clades among samples collected during May to October 2022. The findings highlight the need to strengthen differential diagnostic capacities including multiplex testing, and building genomic surveillance capacities for epidemic intelligence and outbreak response.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ethiopia, Mpox, Outbreak, Varicella-Zoster virus (VZV), VZV clade, Whole-genome sequencing (WGS)
in
Scientific Reports
volume
16
issue
1
article number
148
publisher
Nature Publishing Group
external identifiers
  • pmid:41276648
  • scopus:105026353575
ISSN
2045-2322
DOI
10.1038/s41598-025-29116-w
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2025.
id
654a8184-ab95-448f-b0e4-4581a5b69272
date added to LUP
2026-01-12 07:05:23
date last changed
2026-01-13 03:00:02
@article{654a8184-ab95-448f-b0e4-4581a5b69272,
  abstract     = {{<p>Chickenpox is a highly contagious viral infection caused by varicella-zoster virus (VZV) whose clinical manifestations mimic mpox posing challenges for diagnosis without laboratory confirmation. Here, we investigated VZV among the mpox-suspected cases, May to October 2022, in Ethiopia. Samples were collected from 202 mpox-suspected cases in 11 of Ethiopia’s 14 regions and screened for mpox virus by real-time polymerase chain reaction (RT-PCR). Then, differential testing of other selected orthopoxviruses, VZV and herpes simplex virus (HSV) were conducted for 133 randomly selected samples. Whole-genome sequencing (WGS) and downstream analysis was performed on 8 VZV-positive samples. Descriptive statistics were used to summarize epidemiological and clinical data. All the 202 enrolled cases tested negative for mpox. Of these, 133 samples were tested for VZV, and 107 (80.5%, 95% CI: 72.9% – 86.3%) turned positive but remained negative for HSV and other tested orthopoxviruses. At least one VZV-positive case was reported in each region sampled. Half (49.6%) of the cases were hospitalized, with no fatalities. The sequences were clustered primarily in Clade 5 (62.5%, 5) followed by Clade 3 (25.0%, 2) and Clade 1 (12.5%, 1). This investigation confirmed VZV as the predominant causative agent among mpox-suspected cases. To our knowledge, this represents the first clade-level genomic characterization of VZV from Ethiopia, revealing circulation of multiple clades among samples collected during May to October 2022. The findings highlight the need to strengthen differential diagnostic capacities including multiplex testing, and building genomic surveillance capacities for epidemic intelligence and outbreak response.</p>}},
  author       = {{Tayachew, Adamu and Kebede, Nigatu and Alayu, Mikias and Onywera, Harris and Kanyerezi, Stephen and Agune, Adimikew and Shure, Wolde and Gebeyehu, Ayele and Berkesa, Tsegaye and Getu, Melak and Gedefaw, Lijalem and Amare, Hiwot and Amuri, Biaz and Mbala, Placide and Wanjohi, Dorcas W. and Tessema, Sofonias K. and Teka, Gizaw and Kebede, Mandefro and Logue, Christopher H. and Hailu, Mesay and Arimide, Dawit Assefa and Abte, Melkamu and Wossen, Mesfin}},
  issn         = {{2045-2322}},
  keywords     = {{Ethiopia; Mpox; Outbreak; Varicella-Zoster virus (VZV); VZV clade; Whole-genome sequencing (WGS)}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Nature Publishing Group}},
  series       = {{Scientific Reports}},
  title        = {{Genomic evidence of varicella-zoster virus among Mpox-suspected cases in Ethiopia during the 2022 Mpox multi-country outbreak}},
  url          = {{http://dx.doi.org/10.1038/s41598-025-29116-w}},
  doi          = {{10.1038/s41598-025-29116-w}},
  volume       = {{16}},
  year         = {{2026}},
}