A review on mpox (monkeypox) virus shedding in wastewater and its persistence evaluation in environmental samples

Since May 2022, an outbreak of mpox (formerly known as monkeypox) has been spreading in non-endemic countries and this disease is caused by a mpox virus (MPXV) belonging to Orthopoxvirus genus of the Poxviridae family. Public health surveillance is essential to assess the disease prevalence and spread in the populations. In this purpose, wastewater surveillance has proved to be an effective and affordable tool to detect and monitor disease threats and outbreaks, such as SARS-CoV-2, poliovirus, and other viruses. Prior to the current mpox outbreak, previous studies suggested that MPXV shedding is possible after viral genome and infectious particles were detected in the feces of infected animals. On the other hand, using metagenomic and sequencing approaches to assess the diversity of human viral pathogens in wastewater, contigs assigned to orthopoxviruses and poxviruses were among the most abundant contigs detected in collected samples. Recently, MPXV DNA has been detected in wastewater samples from wastewater treatment plants in cities and airports in the United States, the Netherlands, Italy, France, and Spain. It has long been reported that poxviruses are stable in the environment for long periods and might represent as a source of transmission. However, the stability of MPXV in the environment is unknown and the presence of infectious MPXV in wastewater has not yet been determined. The present work is devoted to reviewing past and recent advances in MPXV detection in wastewater. It also addressed the survival data of orthopoxviruses, which may be of interest to evaluate the persistence of MPXV species in environmental matrices.