Wastewater-Based Surveillance of Mpox (Monkeypox): An Early Surveillance Tool for Detecting Hotspots

This study aims to review recent literature reporting wastewater-based surveillance (WBS) of the monkeypox virus (MPXV) with a major focus on sample collection, processing, and public health safety issues.

Various studies revealed the presence of MPXV genetic markers in sewage, wastewater treatment plants, and drainage systems of hospitals in multiple countries.

Mpox (formally monkeypox) has been identified in more than a hundred countries, confirming at least 93,937 cases from 06 May 2022 to 03 February 2024. The MPXV, the causative agent for mpox, is a zoonotic virus having genome DNA. Major symptoms of the disease are rash, fever, headache, and chills with lymph pain. It has about a 10% case fatality rate, without any approved vaccine, but researchers are investigating the development of therapeutic vaccines. The virus DNA signature has been long reported in urine, stool, saliva, semen, and spit samples of clinical patients, make feasible for tracking the virus in wastewater. Furthermore, recent studies have reported MPXV DNA from environmental samples. As MPXV is a zoonotic virus with possible multiple hosts (e.g., small mammals and rodents), their detection in environmental samples might indicate the possible circulation of the virus including non-human hosts. The persistence of the infective virus particles in the ambient environment has not been fully investigated. Also, their possible risks of transmission through the contaminated milieu are unknown. The WBS can be an effective tool for identifying their hotspots and trends in communities.