Prevalence-adaptive sequential antigen and molecular testing for mpox at the point-of-care

Since its global emergence, mpox epidemiology has been characterised by a combination of explosive multicountry outbreaks and low-level community transmission, particularly within highly interconnected sexual networks.1 Robust diagnostics are essential for preventing transmission, but centralised laboratory PCR often introduces sample-to-result delays that hamper control efforts. Bakamutumaho and colleagues reported that a research-use mpox antigen rapid diagnostic test (lateral flow [LF]) detected only 70·4% (95% CI 65·9–74·6) of PCR-positive cases, with marked variation between sites; although specificity was 89·3% (84·6–92·7), it could and should be higher.