Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jan 15;856(Pt 2):159166.
doi: 10.1016/j.scitotenv.2022.159166. Epub 2022 Oct 3.

Monkeypox outbreak: Wastewater and environmental surveillance perspective

Ananda Tiwari  1 , Sangeet Adhikari  2 , Devrim Kaya  3 , Md Aminul Islam  4 , Bikash Malla  5 , Samendra P Sherchan  6 , Ahmad I Al-Mustapha  7 , Manish Kumar  8 , Srijan Aggarwal  9 , Prosun Bhattacharya  10 , Kyle Bibby  11 , Rolf U Halden  2 , Aaron Bivins  12 , Eiji Haramoto  5 , Sami Oikarinen  13 , Annamari Heikinheimo  14 , Tarja Pitkänen  15
Affiliations
Review

Monkeypox outbreak: Wastewater and environmental surveillance perspective

Ananda Tiwari et al. Sci Total Environ. .

Abstract

Monkeypox disease (MPXD), a viral disease caused by the monkeypox virus (MPXV), is an emerging zoonotic disease endemic in some countries of Central and Western Africa but seldom reported outside the affected region. Since May 2022, MPXD has been reported at least in 74 countries globally, prompting the World Health Organization to declare the MPXD outbreak a Public Health Emergency of International Concern. As of July 24, 2022; 92 % (68/74) of the countries with reported MPXD cases had no historical MPXD case reports. From the One Health perspective, the spread of MPXV in the environment poses a risk not only to humans but also to small mammals and may, ultimately, spread to potent novel host populations. Wastewater-based surveillance (WBS) has been extensively utilized to monitor communicable diseases, particularly during the ongoing COVID-19 pandemic. It helped in monitoring infectious disease caseloads as well as specific viral variants circulating in communities. The detection of MPXV DNA in lesion materials (e.g. skin, vesicle fluid, crusts), skin rashes, and various body fluids, including respiratory and nasal secretions, saliva, urine, feces, and semen of infected individuals, supports the possibility of using WBS as an early proxy for the detection of MPXV infections. WBS of MPXV DNA can be used to monitor MPXV activity/trends in sewerage network areas even before detecting laboratory-confirmed clinical cases within a community. However, several factors affect the detection of MPXV in wastewater including, but not limited to, routes and duration time of virus shedding by infected individuals, infection rates in the relevant affected population, environmental persistence, the processes and analytical sensitivity of the used methods. Further research is needed to identify the key factors that impact the detection of MPXV biomarkers in wastewater and improve the utility of WBS of MPXV as an early warning and monitoring tool for safeguarding human health. In this review, we shortly summarize aspects of the MPXV outbreak relevant to wastewater monitoring and discuss the challenges associated with WBS.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations or those of the publisher, the editors, or the reviewers. RUH is a founding member of AquaVitas, LLC, an Arizona State University startup company working in the field of wastewater-based epidemiology. RUH also is the founder of the ASU non-profit project OneWaterOneHealth that is managed by the Arizona State University Foundation, and that is operating in the same intellectual space.

Figures

Unlabelled Image
Graphical abstract
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Adhikari S., Halden R.U. Opportunities and limits of wastewater-based epidemiology for tracking global health and attainment of UN sustainable development goals. Environ. Int. 2022;163 doi: 10.1016/j.envint.2022.107217. - DOI - PMC - PubMed
    1. Adler H., Gould S., Hine P., Snell L.B., Wong W., Houlihan C.F., Osborne J.C., Rampling T., Beadsworth M.B., Duncan C.J., Dunning J., Fletcher T.E., Hunter E.R., Jacobs M., Khoo S.H., Newsholme W., Porter D., Porter R.J., Ratcliffe L., Hruby D.E.… Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect. Dis. 2022;22(8):1153–1162. doi: 10.1016/S1473-3099(22)00228-6. - DOI - PMC - PubMed
    1. Ahmed W., Angel N., Edson J., Bibby K., Bivins A., O’Brien J.W., Choi P.M., Kitajima M., Simpson S.L., Li J., Tscharke B., Verhagen R., Smith W.J.M., Zaugg J., Dierens L., Hugenholtz P., Thomas K.V., Mueller J.F. First confirmed detection of SARS-CoV-2 in untreated wastewater in Australia: a proof of concept for the wastewater surveillance of COVID-19 in the community. Sci. Total Environ. 2020;728 doi: 10.1016/j.scitotenv.2020.138764. - DOI - PMC - PubMed
    1. Ahmed F., Islam M.A., Kumar M., Hossain M., Bhattacharya P., Islam M.T., Hossen F., Hossain M.S., Islam M.S., Uddin M.M., Islam M.N., Bahadur N.M., Md. Didar-ul-Alam M., Reza H.M., Jakariya M. First detection of SARS-CoV-2 genetic material in the vicinity of COVID-19 isolation centre in Bangladesh: variation along the sewer network. Sci.Total Environ. 2021;776 doi: 10.1016/j.scitotenv.2021.145724. - DOI - PMC - PubMed
    1. Ahmed W., Bibby K., D’Aoust P.M., Delatolla R., Gerba C.P., Haas C.N., Hamilton K.A., Hewitt J., Julian T.R., Kaya D., Monis P., Moulin L., Naughton C., Noble R.T., Shrestha A., Tiwari A., Simpson S.L., Wurtzer S., Bivins A. Differentiating between the possibility and probability of SARS-CoV-2 transmission associated with wastewater: empirical evidence is needed to substantiate risk. FEMS Microbes. 2021;2 doi: 10.1093/femsmc/xtab007. - DOI - PMC - PubMed