Detecting Mpox Cases Through Wastewater Surveillance — United States, August 2022–May 2023

Carly Adams, PhD 1 ,2 ; Amy E. Kirby, PhD 1 ; Megan Bias, MPH 1 ; Aspen Riser, MPH 3 ; Karen K. Wong, MD 4 ; Jeffrey W. Mercante, PhD 1 ; Heather Reese, PhD 1 ( View author affiliations ) View suggested citation Summary What is already known about this topic? CDC’s National Wastewater Surveillance System began testing wastewater for Monkeypox virus in October 2022. The performance of wastewater surveillance for detecting mpox cases is unknown. What is added by this report? Monkeypox virus wastewater detections were compared with reported mpox cases. Wastewater surveillance has a sensitivity of 32% for detecting a single mpox case in wastewater samples that represent thousands to millions of persons. Sensitivity increases as the number of cases in the community increases. Positive and negative predictive values are high. What are the implications for public health practice? An isolated Monkeypox virus wastewater detection likely warrants a limited public health response. Absence of Monkeypox virus detection in a monitored community can provide reassurance that large numbers of cases are not present. Monkeypox virus wastewater surveillance is a useful complement to mpox case surveillance. Article Metrics Altmetric: News (101) X (34) Facebook (1) Citations: Views: Views equals page views plus PDF downloads Metric Details Figure Tables Table 1 Table 2 Related Materials Article PDF Full Issue PDF Abstract In October 2022, CDC’s National Wastewater Surveillance System began routine testing of U.S. wastewater for Monkeypox virus . Wastewater surveillance sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for Monkeypox virus were evaluated by comparing wastewater detections ( Monkeypox virus detected versus not detected) to numbers of persons with mpox in a county who were shedding virus. Case ascertainment was assumed to be complete, and persons with mpox were assumed to shed virus for […]

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