The Current Multicountry Monkeypox Outbreak: What Water Professionals Should Know

Recent water sector safety concerns during the COVID-19 pandemic highlight the need for industry-focused reviews of emerging pathogens to support evidence-based utility decision-making. Between May 7 and August 20, 2022, more than 41358 cases of human monkeypox were reported globally from over 87 countries in which the disease is not endemic. Given that the presence and persistence of monkeypox virus (MPXV) in feces, water, and wastewater has not been investigated, we summarize the available evidence on MPXV and related orthopoxviruses to provide sector-wide recommendations and identify knowledge gaps. On the basis of the information available to date, this outbreak is unlikely to pose an exposure and transmission risk from wastewater, biosolids, or water due to the absence of any evidence to date that suggests that infectious MPXV is present in wastewater or biosolids or has caused human cases, clusters, or outbreaks from exposure to these sources. In addition, remaining smallpox vaccine immunity in the population, availability of vaccines and treatments, susceptibility of poxviruses to disinfection (e.g., UV and chlorine), and evidence from health care confirming the efficacy of infection control measures all suggest that current treatment and recommended wastewater worker protection practices are sufficient to protect public and occupational health.