Predicted failure of common Mpox PCR testing on a recent DRC clade I variant: Persistent genomic surveillance is critically important for accurate diagnostics

Pathogens can rapidly evolve to evade detection via existing diagnostic testing capabilities, creating blind spots for health care and security systems. Persistent genomic surveillance of pathogens can help identify and address these gaps. Here, we present a case study of a new lineage of Monkeypox virus Clade I that emerged during an outbreak in the Democratic Republic of the Congo, in which a genomic deletion allowed the virus to evade detection by current diagnostic assays. We rapidly developed and validated an updated assay. Availability of pathogen genomic data is a critical input, and often a bottleneck, to response efforts.