Scientists examine sewage for monkeypox

The same wastewater surveillance techniques that have emerged as a critical tool in early detection of COVID19 outbreaks are being adapted for use in monitoring the startling spread of monkeypox across the San Francisco Bay Area and some other U.S. communities.

Before the COVID-19 pandemic, wastewater sludge was thought to hold promise as an early indicator of community health threats, in part because people can excrete genetic evidence of infectious diseases — often before they develop symptoms of illness.

Israel has for decades monitored wastewater for polio.

But before COVID-19, such risk monitoring in the U.S. was limited largely to academic pursuits.

With the onset of COVID-19, a research collaboration that involves scientists at Stanford University, the University of Michigan and Emory University pioneered efforts to recalibrate the surveillance techniques for detection of the COVID-19 virus, marking the first time that wastewater has been used to track a respiratory disease.

That same research team, the Sewer Coronavirus Alert Network, or SCAN, is now a leader in expanding wastewater monitoring to detect monkeypox, a once-obscure virus endemic to remote regions of Africa that in a matter of months has infected more than 26,000 people globally and more than 7,000 across the U.S.

The Biden administration this month declared the monkeypox outbreak a public health emergency, following similar decisions by health officials in California, Illinois and New York.

And SCAN’S scientists envision a future in which wastewater sludge serves as a reservoir for tracking a slew of menacing public health concerns.

“We’re looking at a whole range of things that we might be able to test for,” said Marlene Wolfe, an assistant professor of environmental health at Emory.

Since expanding its surveillance in mid-june, the SCAN team has detected monkeypox in several of the 11 Northern California sewersheds it is monitoring.

It is one of a growing number of sewage surveillance projects across the U.S. run jointly by universities, public health agencies, and utilities departments that are feeding COVID-19 findings to state and federal agencies.

Some U.S. communities were sampling sewage before the pandemic to figure out what kinds of opioids residents were using. More recently, along with COVID-19 and monkeypox, the technology has shown promise for monitoring flu and respiratory syncytial virus, or RSV. The federal Centers for Disease Control and Prevention is planning pilot studies to see whether sewage can reveal trends in antibiotic-resistant infections, foodborne illnesses and candida auris, a fungal infection.

“With every new thing that we add to the testing platform, we are learning things,” Wolfe said. “The pandemic really cracked open our imagination for a tool that already existed but that hadn’t been developed to its full capacity. That’s changing now.”