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RALEIGH — The North Carolina Department of Health and Human Services is asking people and providers to be on alert for mpox cases following the detection of mpox particles in multiple sewage samples found through routine wastewater testing. This year there have been two cases of mpox in North Carolina and the new wastewater detections were determined to be another type, clade I, not previously found in North Carolina. These detections indicate potential undiagnosed or unreported cases. At this time, the risk to the public remains low.

The mpox virus, formerly known as monkeypox, is primarily spread by prolonged close contact, typically skin-to-skin, often during sexual activity. There are two genetic types of the virus, known as clade I and clade II. The viral particles found in wastewater were determined to be clade I. To date, only four clade I cases have been reported in the U.S. Clade I mpox is responsible for a large outbreak in Central and Eastern Africa, which appears to be spreading mostly through heterosexual contact with some spread to household members, including children.

North Carolina’s detections were found in wastewater samples collected on March 25, March 28 and April 8 from a treatment plant in Greenville. No clade I cases have been reported to date; however, these detections mean there was possibly at least one person with an undiagnosed or unreported clade I mpox infection present or traveling through the Greenville area around the time of these detections.

“The detection of clade I mpox virus in wastewater surveillance tells us the virus is potentially here in our state, even though no cases have been reported and confirmed,” said NC Health and Human Services Secretary Dev Sangvai. “We encourage health care providers to be on the lookout for mpox cases and we encourage people who are at higher risk to protect themselves by getting vaccinated.”

NCDHHS requests that all North Carolina health care providers consider mpox in patients with compatible symptoms and ask about any recent international travel. Providers who are treating patients with mpox infections should contact their local health department or the NCDHHS Division of Public Health’s 24/7 epidemiologist on-call number: 919-733-3419.

These recent results were found by the North Carolina Wastewater Monitoring Network, which launched in 2021 to better understand the spread of certain viruses in communities across North Carolina. This network is a collaboration between NCDHHS, the University of North Carolina at Chapel Hill, wastewater utilities and local health departments. Samples are collected routinely from 35 wastewater treatment plants across the state and tested for specific viruses, including SARS-CoV-2 (the virus that causes COVID-19), influenza and respiratory syncytial virus (RSV). People with these viruses shed viral particles in their stool even if they don’t have symptoms. These virus particles are no longer infectious but can still be detected through lab testing.

While wastewater surveillance has become a valuable tool for tracking and responding to viruses, the program is now at risk due to proposed federal funding cuts. Wastewater surveillance funding allows North Carolina to have a crucial early warning system for levels of infections that can help public health officials and health care providers make decisions, such as providing guidance on how to prevent infections.

NC Wastewater Monitoring Network results are routinely shared on the NCDHHS wastewater monitoring dashboard. Testing for mpox is done on samples from 18 of the participating sites and results are shared on the CDC Mpox wastewater dashboard.

If you think you have mpox or have had close contact with someone who has mpox, visit your health care provider or contact your local health department. Symptoms include a rash on any part of the body, like the genitals, hands, feet, chest, face or mouth. The rash can initially look like pimples or blisters and may be painful or itchy. The rash will go through several stages, including scabs, before healing. Some people experience flu-like symptoms before the rash, while others get a rash first followed by other symptoms. In some cases, a rash is the only symptom experienced.

Vaccines are available to protect against mpox infection from both clade types and can reduce the severity of illness if infection does occur. Information about vaccine recommendations and where to find vaccine is available on the NCDHHS mpox page.