Recent
water sector safety concerns during the COVID-19 pandemic
highlight the need for industry-focused reviews of emerging pathogens
to support evidence-based utility decision-making. Between May 7 and
August 20, 2022, more than 41 358 cases of human monkeypox
were reported globally from over 87 countries in which the disease
is not endemic. Given that the presence and persistence of monkeypox
virus (MPXV) in feces, water, and wastewater has not been investigated,
we summarize the available evidence on MPXV and related orthopoxviruses
to provide sector-wide recommendations and identify knowledge gaps.
On the basis of the information available to date, this outbreak is
unlikely to pose an exposure and transmission risk from wastewater,
biosolids, or water due to the absence of any evidence to date that
suggests that infectious MPXV is present in wastewater or biosolids
or has caused human cases, clusters, or outbreaks from exposure to
these sources. In addition, remaining smallpox vaccine immunity in
the population, availability of vaccines and treatments, susceptibility
of poxviruses to disinfection (e.g., UV and chlorine), and evidence
from health care confirming the efficacy of infection control measures
all suggest that current treatment and recommended wastewater worker
protection practices are sufficient to protect public and occupational
health.