{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T03:47:06Z","timestamp":1768880826087,"version":"3.49.0"},"reference-count":16,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Background\/Objectives: Mpox re-emerged in 2022 as a global health concern. Between 2022 and 2025, Portugal experienced three distinct outbreak waves, highlighting the critical role of laboratory surveillance and public health interventions. This study describes the epidemiological trends, diagnostic performance, and key lessons learned to improve outbreak preparedness. Methods: A total of 5610 clinical samples from 2802 suspected cases were analyzed at the National Institute of Health Doutor Ricardo Jorge using real-time PCR methods. Positivity rates and viral loads (Ct values) were assessed across different clinical specimen types, including lesion, anal, oropharyngeal swabs, and urine samples. Results: Mpox was confirmed in 1202 patients. The first outbreak accounted for 79.3% of cases (n = 953), followed by a significant reduction in transmission during subsequent waves. Lesion and rectal swabs provided the highest diagnostic sensitivity (95.1% and 87.9%, respectively). Oropharyngeal swabs contributed to diagnosis in cases without visible lesions, while urine samples showed limited utility. Conclusions: This study underscores the importance of sustained laboratory surveillance and adaptive public health strategies in controlling mpox outbreaks. Optimizing specimen collection enhances diagnostic accuracy, supporting early detection. Continuous monitoring, combined with targeted vaccination and effective risk communication, is essential to prevent resurgence and ensure rapid response in non-endemic regions.<\/jats:p>","DOI":"10.3390\/idr17040086","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T10:35:31Z","timestamp":1753094131000},"page":"86","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mpox Surveillance and Laboratory Response in Portugal: Lessons Learned from Three Outbreak Waves (2022\u20132025)"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5321-3657","authenticated-orcid":false,"given":"Rita","family":"Cordeiro","sequence":"first","affiliation":[{"name":"Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisbon, Portugal"},{"name":"Institute of Environmental Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal"}]},{"given":"Rafaela","family":"Francisco","sequence":"additional","affiliation":[{"name":"Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisbon, Portugal"},{"name":"Egas Moniz Interdisciplinary Research Center, Egas Moniz School of Health & Science, 2829-511 Caparica, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4770-9079","authenticated-orcid":false,"given":"Ana","family":"Pelerito","sequence":"additional","affiliation":[{"name":"Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisbon, Portugal"},{"name":"Institute of Environmental Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4693-3952","authenticated-orcid":false,"given":"Isabel","family":"Lopes de Carvalho","sequence":"additional","affiliation":[{"name":"Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisbon, Portugal"},{"name":"Institute of Environmental Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5182-6150","authenticated-orcid":false,"given":"Maria Sofia","family":"N\u00fancio","sequence":"additional","affiliation":[{"name":"Emergency Response and Biopreparedness Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, 1649-016 Lisbon, Portugal"},{"name":"Institute of Environmental Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"772","DOI":"10.3390\/idr14050079","article-title":"Monkeypox: From a neglected tropical disease to a public health threat","volume":"14","author":"Antunes","year":"2022","journal-title":"Infect. Dis. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S0140-6736(22)02075-X","article-title":"Monkeypox","volume":"401","author":"Ogoina","year":"2023","journal-title":"Lancet"},{"key":"ref_3","unstructured":"World Health Organization (2025, April 07). Global Mpox Trends. 4 April 2025. Available online: https:\/\/worldhealthorg.shinyapps.io\/mpx_global\/."},{"key":"ref_4","unstructured":"World Health Organization (2025, June 26). Multi-Country Outbreak of Mpox. External Situation Report #49. 28 March 2025. Available online: https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-mpox--external-situation-report--49---28-march-2025."},{"key":"ref_5","unstructured":"World Health Organization (2024). Diagnostic Testing and Testing Strategies for Mpox: Interim Guidance."},{"key":"ref_6","unstructured":"Directorate-General of Health (2025, June 26). 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Med."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/4\/86\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:13:08Z","timestamp":1760033588000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/4\/86"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["idr17040086"],"URL":"https:\/\/doi.org\/10.3390\/idr17040086","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,21]]}}}