Monkeypox Outbreak: Wastewater and Environmental Surveillance Perspective

Ananda Tiwari, Sangeet Adhikari, Devrim Kaya, Md. Aminul Islam, Bikash Malla, Samendra P. Sherchan, Ahmad Ibrahim Al-Mustapha, Manish Kumar, Srijan Aggarwal, Prosun Bhattacharya, Kyle Bibby, Rolf U. Halden, Aaron Bivins, Eiji Haramoto, Sami Oikarinen, Annamari Heikinheimo, Tarja Pitkänen

Research output: Contribution to journalReview Articlepeer-review


Monkeypox disease (MPXD), a viral disease caused by 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 for monitoring communicable diseases, particularly during the ongoing coronavirus disease, the COVID-19 pandemic It helped to monitor infectious disease caseloads as well as specific viral variants circulating in communities. The detection of MPXV DNA in 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 MPXV outbreak relevant to wastewater monitoring and discuss the challenges associated with WBS.
Original languageEnglish
Article number159166
JournalThe Science of the Total Environment
Issue number2
Number of pages7
Publication statusPublished - 2 Oct 2022
MoE publication typeA2 Review article in a scientific journal

Fields of Science

  • 1172 Environmental sciences

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