Wednesday, September 28, 2022

Monkeypox: Virus found in sewage in USA

Last month, the Stanford Sewer Coronavirus Alert Network (SCAN) added monkeypox to the list of viruses it checks for every day wastewater. Since then, monkeypox has been detected in ten of the eleven sewage systems surveyed by SCAN, including Sacramento, Palo Alto, and several other cities in the Bay Area of ​​California.

As of July 21, 2,593 cases of monkeypox have been reported in the United States. The virus has been detected in 74 countries around the world, of which 68 have never reported monkeypox in the past. On 23 July, the World Health Organization (WHO) declared the virus outbreak a global public health emergency. Monkeypox cases were first reported in Germany in May. Since then, a total of 2,540 cases of monkeypox have been reported from all 16 federal states, according to the Robert Koch Institute.

SCAN began monitoring Californian wastewater for Sars-Cov-2 in 2020. It is currently the only public project in the US that also tests for the presence of monkeypox in shower, sink and toilet water that is sent to sewage treatment plants for decontamination. Extracting genetic material from solids contained in raw, untreated wastewater can provide information about where the virus or bacterium has spread and how widespread the outbreak is.

Over the past two years, the concentration of SARS-CoV-2 virus in wastewater has shown the growth of confirmed COVID-19 cases by testing on individuals. In late 2021, wastewater monitoring indicated that the Omicron variant was common in the US long before clinical trials indicated.

Now, early data suggest that monkeypox levels in wastewater may also shed light on cases of monkeypox in the community, says Alexandria Boehm of Stanford University, who co-directs the scan and studies pathogen transmission.

Now Boehm and his colleagues use their wastewater data to estimate the actual number of people infected with monkeypox in the communities they monitor. To do this, they model how sewage data and monkeypox cases over the past month are related. This estimate, which can be updated daily, would allow tracking the spread of the disease in communities, much faster than waiting for symptomatic patients to see a doctor and get tested.

Unlike a COVID test, monkeypox can only be tested for if the patient already has skin lesions so that doctors can examine them. These skin lesions do not appear until a week or two after a person has been infected. By monitoring wastewater, monkeypox infection could be detected much earlier.

This approach is particularly useful when clinical trials are hampered. Everyone has a bowel movement, but very few get tested for monkeypox. Before June 22, only 70 of the more than 200 CDC laboratories nationwide were authorized to test for monkeypox. Five companies have now got approval to conduct trials, but expansion will take time.

However, the lack of testing, and therefore the lack of accurate data on monkeypox infection, makes it difficult to build a model that uses wastewater to estimate monkeypox cases, as the actual relationship between the two is difficult to establish.

Monkeypox belongs to the same virus family as smallpox, but is less contagious and generally causes mild symptoms. They’re unpleasant nonetheless: In addition to flu-like symptoms, telltale signs include the appearance of pus-filled blisters on the face, arms, legs, or genitals. If water flows over these open wounds in the shower or while washing hands, viral DNA can get into the sewage system.

Recent data indicate that the pathogen genome can also be detected in the body fluids of infected people. These include respiratory and nasal secretions, sputum, urine, feces and semen. This means that the washed tissue from a person with monkeypox can be registered as a virus in sewage.

If the genetic footprint of a pathogen can remain in wastewater for more than 24 hours, the scan may be able to detect it. The viral RNA of the Sars-Cov-2 virus can be detected for more than ten days. Although monkeypox DNA appears to exceed the 24-hour limit, there has been no public research on how long this lasts.

The question is how much monkeypox DNA has to go into sewage for the scan to actually detect it. The scan can smell covid from the sewage of only two infected people in a lakh.

Even in a state like California, where sewage and sewerage are separate, rain reduces the amount of viral DNA in sewage. To account for this, Scan normalizes his estimates for a virus with a well-known expected quantity—the paper mild mottled virus. Healthy people release the harmless virus after eating chili and pepper-based products, making it the most abundant RNA virus in human feces. Conveniently, it is very stable even in water.

There is no evidence that sewage can transmit monkeypox. According to the World Health Organization, human-to-human transmission occurs through prolonged, close contact with an infected person who comes into direct contact with their rash, body fluids or respiratory droplets. The bedding and clothing of people with monkeypox can also spread the virus.

There is a vaccine against monkeypox. The smallpox vaccine in its national stockpile in the US also provides protection against the virus. However, public access to monkeypox testing, treatments and vaccines is limited. So sewage testing can help public health officials identify monkeypox outbreaks without widespread testing and decide how to invest resources.


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Sewage monitoring can also detect new monkeypox variants, two of which are currently circulating in the United States. Virtually the entire current outbreak is due to the West African strain of the pathogen, for which SCAN has a specific test. This strain is more contagious but far less lethal than other strains known as Congo Basin clones. In recent years, between three and six percent of those infected have died from monkeypox, a disease that is even more deadly in young children. This year, three people have died due to this disease worldwide.

SCAN is currently the only project to publish data on monkeypox in wastewater. “The Gulf region is at the forefront of wastewater monitoring because we are Silicon Valley,” Boehm says. “But it’s not like monkeypox is in the sewage in California and nowhere else.”


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