Wastewater and environmental surveillance (WES) has potential to provide actionable information as part of multimodal surveillance for mpox. Use cases are; early detection, as well as reassurance of the absence, of transmission to enable targeted risk communication and responses, differentiation of circulating virus clades subject to validation and optimization of clade specific laboratory methods, and quantification of trends particularly in sewered and moderate to high case load settings if research further validates consistent correlation with cases.

Case-based surveillance for mpox remains the priority and any WES must be integrated as part of multimodal surveillance. Technical and operational feasibility of WES has been demonstrated in sewered settings and to a lesser extent in unsewered settings. Cost-efficiency may be optimized though integration with existing WES for other targets (e.g., polioviruses or SARS-CoV-2). Ethical and legal aspects should be considered, particularly for vulnerable or marginalized population groups. Further research is needed to outline best practice and develop recommendations on WES for mpox.