{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T23:13:12Z","timestamp":1789168392359,"version":"build-2803163510"},"reference-count":45,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:00:00Z","timestamp":1692230400000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Medical Virology"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The global mpox outbreak spanning 2022\u20132023 has affected numerous countries worldwide. In this study, we present the first report on the detection, whole\u2010genome sequence, and coinfection of the mpox virus and varicella zoster virus (VZV) from Pakistan. During April\u2013May 2023, samples from 20 suspected cases of mpox were tested at the National Institutes of Health, Islamabad among which 4 tested positive. All four cases had a travel history of Saudi Arabia. All the suspected samples were processed by using a Zymo research kit for DNA extraction, followed by qRT\u2010PCR amplification by using a DaAn Gene detection kit for the mpox virus. Further, two of the positive samples with a low <jats:italic>C<\/jats:italic><jats:sub>t<\/jats:sub> value (&lt;20) were subjected to whole\u2010genome sequencing using a metagenomic approach on the iSeq (Illumina) platform. The sequencing results revealed Clade IIb and genotype A.2.1 of MPXV, which clustered with viruses from Slovenia and the UK in July and June 2022, respectively. Our analysis identified two novel nonsynonymous substitutions in mpox virus, namely V98I in OPG046 and P600S in OPG109. Furthermore, we successfully retrieved the complete genome of VZV from the same sample, belonging to Clade 5. This study represents the first positive case of MPXV in Pakistan and the coinfection of mpox and VZV by using a metagenome approach providing insights into their complete genomes. Our results highlight the importance of surveillance at the point of entries, strengthening lab capacities including next\u2010generation sequencing, and using differential diagnosis for timely and accurate detection of mpox cases.<\/jats:p>","DOI":"10.1002\/jmv.29037","type":"journal-article","created":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T21:58:42Z","timestamp":1692568722000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Genomic characterization of the first mpox and varicella\u2010zoster co\u2010infection in Pakistan (2023) through next\u2010generation sequencing"],"prefix":"10.1002","volume":"95","author":[{"given":"Massab","family":"Umair","sequence":"first","affiliation":[{"name":"Department of Virology National Institute of Health Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zunera","family":"Jamal","sequence":"additional","affiliation":[{"name":"Department of Virology National Institute of Health Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed A.","family":"Haider","sequence":"additional","affiliation":[{"name":"Department of Virology National Institute of Health Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabia","family":"Hakim","sequence":"additional","affiliation":[{"name":"Department of Virology National Institute of Health Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Ammar","sequence":"additional","affiliation":[{"name":"Department of Virology National Institute of Health Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qasim","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Virology National Institute of Health Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5344-2027","authenticated-orcid":false,"given":"Nasim","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department Pakistan Institute of Medical Sciences Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aamer","family":"Ikram","sequence":"additional","affiliation":[{"name":"Department of Virology National Institute of Health Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Salman","sequence":"additional","affiliation":[{"name":"Department of Virology National Institute of Health Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,17]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Fields Virology","author":"Esposito J","year":"2001"},{"key":"e_1_2_9_3_1","volume-title":"Sherris Medical Microbiology: An Introduction to Infectious Diseases","author":"Ryan KJ","year":"1994"},{"key":"e_1_2_9_4_1","unstructured":"WHO Director\u2010General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern. 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