Going beyond SARS-CoV-2: genomic surveillance of monkeypox in German wastewater

Fear of stigma poses a challenge in tracking the 2022-outbreak of monkeypox virus (MPXV) infection. Patients shed MPXV via skin lesions, gastrointestinal route, and seminal fluids into the wastewater. Monitoring MPXV in wastewater can support tracking transmission. We developed a sensitive NGS panel “P4Mpox22”, to track MPXV in sewage. Since May 2022, we have monitored the sewage of German cities using P4Mpox22 and dPCR to quantify MPXV. Despite only 12 clinical cases reported in the respective sewersheds, we obtained up to 90% MPXV genome coverage. Sewage-derived MPXV genomes cluster with lineage B.1 and exhibit APOBEC-type hypermutations. Using dPCR, we quantified MPXV even in sewersheds with only one clinical case. We show that MPXV sewage monitoring using existing SARS-CoV-2 wastewater surveillance infrastructure could be implemented immediately. One-Sentence Summary Human monkeypox virus sequencing in wastewater enables community-wide surveillance while overcoming stigmatization challenges