Sewage tests could help identify the spread of monkeypox

As sewage test continues to prove useful to estimate the spread of the coronavirus, scientists are again using sewage to track the latest public health emergency: monkey pox.

Late June — about a month after the first California case has been confirmed – monkeypox DNA has been detected in San Francisco sewage, according to the WastewaterSCAN coalitiona group of scientists who have been testing wastewater for the presence of the coronavirus since 2020.

The group recently confirmed the presence of the monkey pox virus in Los Angeles County trash.

“It helps to understand how widespread this is,” said Alexandria Boehm, a Stanford professor of civil and environmental engineering, one of the lead researchers on the WastewaterSCAN team.

She said COVID-19 sewage testing has been particularly helpful during the “appearance phase,” or immediately after a new variant has been identified, but the extent of its presence is unclear. Public health officials can use this information to theorize the extent of the spread.

“We are kind of in this [phase] for monkeypox now,” Boehm said.

Monkeypox DNA was first detected in Los Angeles County wastewater on July 31, about 20 days after the WastewaterSCAN group expanded monkeypox testing beyond the Bay Area to nearly of 40 other facilities nationwide – including in Los Angeles – according to group data.

Samples from the Los Angeles Joint Water Pollution Plant in Carson, which serves about 4 million residents and businesses, showed a small presence of the monkeypox virus on July 31 and for three days during the first week of August. , according to WastewaterSCAN The data. The virus has not been detected there since, despite an increase in monkeypox cases in Los Angeles County.

By comparison, monkeypox DNA has been detected nearly every day since June 27 at two San Francisco sewage treatment plants — and at much higher levels than in LA County.

Still, Boehm said that doesn’t mean there’s no more monkeypox in Los Angeles County; it’s just hard to detect among the massive sample size.

Because the Los Angeles sewage treatment facility serves such a large number of people, “you have to think about the sensitivity of detecting monkeypox versus the incident rate in the population,” said Bohm. “Just because you don’t detect monkeypox doesn’t mean there’s no one there. [in that waste watershed] with monkeypox.

The two facilities in San Francisco serve a much smaller population, approximately 100,000 residents each.

While Los Angeles and San Francisco have seen a rapid increase in monkeypox cases in recent weeks, the totals still represent only a fraction of each county’s population: approximately 600 in San Francisco among less than one million inhabitants and approximately 1,000 in LA County among 10 million residents, according to each county’s public health department.

“We do [wastewater] monkeypox surveillance, and it has just been identified,” the Los Angeles Department of Public Health said in a statement. “It took longer to identify here than in some places most likely because we have a large population compared to the number of cases. Wastewater monitoring is relatively new and somewhat experimental.

It was not immediately clear whether the LA County Health Department planned to expand sewage monkeypox testing or how it would use the data. The county has been monitoring wastewater for coronavirus for months, including at the joint water pollution plant, as well as the Hyperion water reclamation plant in Playa Del Rey and facilities near Lancaster. and Malibu.

When home COVID-19 test began to limit the ability to monitor case numbers, LA County public health officials often used sewage data to track transmission trends — a factor that played a role in a decision not to implement another inner mask mandate.

“It’s useful to have this additional focus on disease epidemiology and dynamics because it’s not based on people’s behaviors or testing,” Boehm said. “There is a kind of health equity component.”

She said wastewater data can help inform public health decisions, such as targeting information, clinics or treatments.

The scientists behind WastewaterSCAN call the virus data “invaluable”, having already found monkeypox at 22 wastewater treatment facilities in California, from San Diego to Sacramento, as well as nine facilities in seven other states.

There is not yet a national database to track monkeypox in waste, such as CDC made for COVID-19, but Boehm said she would like to see testing expand. Her team is also working to test sewage for influenza A and respiratory syncytial virus (RSV), which she hopes can continue to help answer questions about viral transmission.

She said she would like the sewage tests, which have proven to be extremely accurate, to be used to inform care, treatment and even vaccine development of current viral outbreaks – as well as future ones.

“I’m a scientist, so I’m just curious how far we can go,” Boehm said. “It turns out to be a really interesting and amazing resource for understanding public health.”

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