Wastewater testing in Greenville, North Carolina has detected Mpox, specifically the clade I strain, in samples collected from late March to early April. While no clinical Mpox cases have been officially reported in the area, health officials stress vigilance among clinicians and rapid reporting of suspected infections. This development underscores wastewater-based surveillance as a powerful tool for early outbreak detection.
Thailand and other countries watching infectious diseases should take note. Wastewater-based surveillance (WBS) gained prominence during the COVID-19 era and continues to reveal hidden viral activity by capturing signals from individuals who are pre-symptomatic or have mild infections. According to experts in North Carolina, the presence of clade I mpox virus in wastewater suggests the virus may be circulating locally, even without confirmed cases.
Mpox spreads mainly through prolonged close contact, including during sexual activity. Symptoms often include fever, swollen lymph nodes, and a distinctive rash that can appear on multiple body areas. While most cases are mild, vulnerable groups—such as those with compromised immune systems—face higher risks of complications. Public health authorities advise healthcare providers to consider Mpox in differential diagnoses when patients present compatible symptoms and exposures.
Why this matters for Thailand: the country has invested in disease surveillance, yet much of the focus remains on clinical reporting and border controls. Wastewater surveillance offers a broader, real-time view of pathogen presence in communities, potentially catching outbreaks earlier than traditional testing. A 2025 systematic review found Mpox positivity in wastewater averages around 22 percent globally, reinforcing wastewater analysis as a reliable indicator of community transmission.
Innovations in modeling also support wastewater data. A recent AI-augmented study linked sewage concentrations of Mpox DNA to clinical case counts, suggesting that wastewater signals could forecast outbreaks with high accuracy. This points to a practical path for integrating environmental monitoring into Thailand’s public health toolkit, especially in urban centers and major events where transmission risk is elevated.
The clade I strain detected in Greenville is notable because most reported Mpox outbreaks outside Africa involve clade IIb. Clade I, historically seen in Central Africa, has been associated with greater severity in some cases. While there is no evidence that Greenville’s strain originated in Africa, the finding highlights the importance of vigilance even where clinical cases are not yet evident.
Historically, Thailand recalls the 2022-2023 Mpox concerns, which drew attention to high-contact groups and the need for targeted vaccination and education. In Thai culture, discussing diseases linked to sexual health can be sensitive, but the COVID-19 experience has shown Thais are increasingly open to proactive public health measures and surveillance innovations.
Public health leaders in Thailand should consider expanding wastewater surveillance programs. Real-time, city- and region-wide monitoring can inform faster interventions when clinical data lag. Lessons from programs in other countries show that privacy, ethics, and capacity must be carefully managed, but the benefits of early warning are clear.
Looking ahead, the growing threat of zoonotic and emerging infections means Thailand cannot rely solely on traditional methods. Experts emphasize environmental surveillance as a game-changer for glimpsing the unseen parts of an outbreak. Thailand’s status as a travel and tourism hub makes robust monitoring especially important, given past experiences with dengue and other waves.
What should Thailand do next? Agencies should pilot wastewater surveillance in major urban centers and border provinces, focusing on large treatment facilities and neighborhoods with high traveler traffic. Health workers should receive ongoing training to recognize Mpox symptoms and report suspected cases promptly. Community education is essential to reduce stigma and encourage timely care-seeking, regardless of suspected sources.
For the public, practical steps remain simple: maintain good personal hygiene, avoid close contact with individuals who have unexplained rashes or flu-like symptoms, and seek medical advice promptly if symptoms develop. Embracing wastewater surveillance alongside traditional methods will strengthen Thailand’s ability to detect and respond to both familiar and emerging infectious threats.
In sum, wastewater surveillance is a valuable addition to Thailand’s disease surveillance toolkit. It helps reveal the hidden dynamics of Mpox and other pathogens, supporting quicker, smarter public health decisions for a safer community.