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The 2022 mpox outbreak in the U.S. and other previously nonendemic parts of the world came as a surprise. Because of the stigma attached to this disease (engendered by the fact that it was primarily spread by men who have sex with men), the incidence and prevalence of mpox were probably underreported.
Testing of regional wastewater for evidence of potential pathogens (such as SARS-CoV-2 and poliovirus; NEJM JW Infect Dis Dec 2022 and Lancet 2022 Oct 29; 400:1531) has proven useful in estimating infectious disease prevalence while yielding data on the degree of underreporting. Using PCR-based assays, researchers in collaboration with the California Department of Health determined the amount of mpox virus (MPXV) DNA in settled solid waste mate…