Utilizing Wastewater Testing to Monitor mpox Outbreaks

In a recent study, the authors delve into the findings from the CDC's National Wastewater Surveillance System, which initiated routine testing for the mpox (formerly monkeypox) virus in US wastewater in October 2022. This testing followed a global outbreak primarily affecting men who have sex with men.

The study, encompassing samples collected from August 2022 to May 2023, aimed to assess the sensitivity and predictive values of wastewater mpox detection. People with mpox are presumed to shed the virus for up to 25 days post-symptom onset.

The study defines Positive Predictive Value (PPV) as the likelihood of at least one person shedding the virus when wastewater detection occurs, while Negative Predictive Value (NPV) is the likelihood of no one shedding the virus when no wastewater detection happens.

Results indicated that in a single week, from samples representing thousands to millions of individuals, wastewater mpox detection had a sensitivity of 32% for detecting one or more people shedding the virus, 49% for detecting five or more people shedding the virus, and 77% for detecting 15 or more people shedding the virus.

The PPV was 72.6% for predicting a single case per day and 61.9% for predicting a case weekly. NPV for predicting the absence of anyone shedding mpox virus in a county on a given day or week was 72.9% and 80.3%, respectively.

The authors noted, "When Monkeypox virus was detected in wastewater on a single day or week, there was most likely (but not always) at least one case present in the county." The absence of mpox in wastewater, combined with no reported cases, can offer reassurance to public health officials about the absence of a large number of cases.

Another study highlights moderate levels of mpox transmission in LA County during the spring and summer of the previous year, emphasizing the significance of vaccination.

While LA County experienced some of the nation's highest mpox levels in 2022, there was a steady decrease until May 2023, when a slight increase was observed. During May 4 to August 17, 2023, researchers identified 56 mpox patients, with only 29% fully vaccinated. No deaths were reported, and one patient was hospitalized.

This outbreak emphasizes the continuous need for accessible mpox vaccination, particularly for those at risk of severe disease, such as individuals with uncontrolled or advanced HIV, and groups with low vaccination coverage, including young, Black, and Hispanic individuals, as well as those living with HIV.

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