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Experts say waste water testing, crucial for COVID-19, could be useful for monkeypox — and the next big disease

A fish eye view of the MWRA Deer Island Waste Water Treatment Plant located on Deer Island Winthrop.David L. Ryan/Globe Staff

Waste water surveillance testing has become a key tool in monitoring the COVID-19 pandemic. Now researchers say the same technique could be used to track the growing monkeypox outbreak, along with other diseases.

Researchers with WastewaterSCAN, a collaboration between Stanford and Emory universities, have found traces of monkeypox in waste water in 6 of 10 states where they are testing — California, Colorado, Idaho, Texas, Michigan, and Georgia — said Alexandria Boehm, a Stanford professor who is one of the program’s leaders.

Cambridge-based Biobot Analytics Inc., which conducts waste water surveillance testing in Massachusetts and at hundreds of sites nationwide, plans to offer testing for traces of monkeypox within about a month, the company said.


Waste water testing is the best and “most cost-effective way to understand public health threats from infectious diseases in communities for a wide range of diseases,” said David Larsen, an associate professor at Syracuse University who played a key role in establishing New York state’s waste water surveillance program.

The federal government last week declared the monkeypox outbreak a national health emergency. The US Centers for Disease Control and Prevention says that as of Thursday there were more than 10,000 cases recorded nationwide.

Boehm said that once waste water samples have been collected, testing doesn’t have to be limited to the original target, SARS-CoV-2, the virus that causes COVID-19, and can be expanded to include monkeypox and other diseases.

“It’s pretty straightforward to swap in different assays for different important targets. It’s a great way to be prepared for the next pandemic,” she said. WastewaterSCAN has also been testing samples for influenza and RSV, two respiratory viruses that spread across the country during the colder months every year.

Newsha Ghaeli, Biobot co-founder and president, said the hope is that the monkeypox testing currently under research and development by the company can “really help us better understand this disease.”


Biobot, founded in 2017 with an initial focus on testing sewage for opioids to help communities address the opioid epidemic, pivoted swiftly after the pandemic swept the nation to begin testing for the coronavirus. It is now the biggest player in the waste water surveillance testing business, said Ghaeli. It currently does testing for about 500 sites in all 50 US states.

Ghaeli said Massachusetts officials have inquired about Biobot’s plans for monkeypox testing. State officials say they currently have no plans to test for monkeypox.

Ghaeli said the company is also considering testing for polio in waste water as concern has been rising about the disease making a comeback after being nearly eradicated worldwide. Waste water surveillance for polio has been used in the past in Israel to control outbreaks. In recent days, it has made headlines in the United States after poliovirus was discovered in waste water in New York City and a suburb, prompting officials to urge people to get vaccinated.

Larsen said the same waste water sample can be used to test for “tens, if not hundreds” of diseases. One caveat, he said, is that the technique “won’t work very well for a disease that doesn’t shed in the waste water,” but he added, “I haven’t found an example of that yet.”

Waste water surveillance got a big boost from its performance during the COVID-19 pandemic, when it became a key metric to understand the spread of the virus, researchers said.


“It definitely supercharged this field,” said Boehm. “Over the course of the pandemic, we realized waste water could be a really great resource.”

The CDC, acknowledging the value of waste water testing for the coronavirus, established the National Wastewater Surveillance System to “coordinate and build the nation’s capacity” to track coronavirus levels in waste water around the country.

An editorial last week in the journal Nature Microbiology called for routine waste water monitoring to “be deployed around the world to mitigate the spread of pathogens, both old and new.”

Sam Scarpino, a vice president at the Pandemic Prevention Institute of the Rockefeller Foundation, said, “Multi-pathogen waste water surveillance has the potential to transform global public health in terms of its ability to tell us what’s making people sick in real time and in a less biased way than many traditional surveillance systems. ... We absolutely need multi-pathogen surveillance.”

CDC officials, too, have said they recognize the value of testing for more diseases. Amy Kirby, team lead for the NWSS, said in a February press briefing that waste water surveillance for COVID-19 was “giving us a glimpse into a new frontier of infectious disease surveillance in the US.”

“One of the strengths of waste water surveillance is that it is very flexible. So once we have built this infrastructure to collect the samples, get them to a laboratory, get the data to CDC, we can add tests for new pathogens fairly quickly. So ... should there be a new pathogen of interest, we could ramp up this system within a few weeks to start gathering community-level data on that new pathogen,” she said.


The CDC said in a statement it was “exploring the possibility of monitoring for monkeypox virus in waste water but has not released any recommendations on waste water surveillance of this virus.”

Ghaeli and the researchers noted there is a major obstacle ahead for a field that they believe could be key to protecting people’s health.

With the testing dependent on government funding, “The biggest barrier is money,” said Larsen. “Public health surveillance, in general, is not well funded.”

Ghaeli said that once a sample is collected, it is only a “nominal or fractional” increase to do other tests on the water.

“We’ve always believed it should be an integral part of our public health intelligence system,” she said. “Our vision is that waste water monitoring becomes a permanent infrastructure layer on top of our sewer systems.”

Martin Finucane can be reached at martin.finucane@globe.com.