Wastewater and environmental surveillance as an early warning system and public health tool for mpox outbreak detection and management: a scoping review

Abstract

Background: Wastewater and environmental surveillance (WES) has demonstrated the potential to detect signal for the mpox virus (MPXV), thereby supporting public health efforts to mitigate outbreaks. The aim of this scoping review was to document the use of WES as an early warning system and public health tool for mpox outbreak management. Methods: A systematic search was conducted in PubMed, Web of Science and Scopus in August 2024, and updated in April 2025, to identify eligible studies using the PCC framework. Results: The search yielded 256 records. Title and abstracts were screened for 140 records. Full text screening was done on the remaining 43 records, of which 10 further records were excluded. A total of 33 studies, published between 2022 and 2024, were included for synthesis in this review. Twenty-two studies reported a positive correlation/association between trends of MPXV in wastewater data and the reported cases on mpox. Four studies included in this scoping review reported the detection of MPXV in wastewater before clinical cases. Other studies reported negative associations, as well as false positive and false negative results from WES for mpox. Surveillance was predominantly conducted at wastewater treatment plants (91%), leaving a gap in surveillance of non-sewered settings. The qPCR method was reported by 61% of studies for molecular analysis. However, assessments of the qPCR method are needed to improve sensitivity and accuracy in the quantification of MPXV in wastewater. Conclusions: Further research is needed to improve the capability of WES to provide early indication of mpox outbreaks and inform the accurate quantification of MPXV in wastewater to serve as an early warning system.