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Volume 32, Supplement –Summer 2026

SUPPLEMENT ISSUE
Supplement

Monkeypox Virus Surveillance in Wastewater, North Carolina, USA, October 2023–May 2025

Nicole L. SnyderComments to Author , Thomas Clerkin, Sarah H. Koenigsberg, Mara B. Tate, Ty L. Lautenschlager, Justin Albertson, Emma L. Doran, Erica F. Wilson, Rachel T. Noble, Virginia T. Guidry, and Ariel R. Christensen
Author affiliation: Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA (N.L. Snyder, S.H. Koenigsberg, M.B. Tate, T.L. Lautenschlager, J. Albertson, E.L. Doran, E.F. Wilson, V.T. Guidry, A.R. Christensen); Institute of Marine Sciences, University of North Carolina at Chapel Hill, Morehead City, North Carolina, USA (T. Clerkin, R.T. Noble); Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA (R.T. Noble)

Main Article

Table 3

Diagnostic characteristics stratified by wastewater treatment plant/sewershed in study of mpox surveillance in wastewater, North Carolina, USA, October 2023–May 2025

Sewershed TP FP TN FN Sensitivity, % (95% CI) Specificity, % (95% CI) PPV, % (95% CI) NPV, % (95% CI)
Cary 1 0 2 5 0 – 71.4 (35.9–91.8) <1 (0–65.8) 100 (56.6–100)
Cary 2 0 0 7 0 – 100 (64.6–100) – 100 (64.6–100)
Cary 3
 0
 1
 2
 4
 <1 (0–49.0)
 66.7 (20.8–93.9)
 <1 (0–79.3)
 33.3 (9.7–70.0)
Chapel Hill
 0
 0
 2
 0
 –
 100 (34.3–100)
 –
 100 (34.3–100)
Charlotte 1 0 4 78 0 – 95.1 (88.1–98.1) <1 (0–49.0) 100 (95.3–100)
Charlotte 2 6 0 60 18 25 (12.0–45.0) 100 (93.8–100) 100 (61.0–100) 77.0 (66.4–84.9)
Charlotte 3 3 0 52 23 11.5 (3.5–29.0) 100 (93.1–100) 100 (43.9–100) 69.3 (58.2–78.6)
Charlotte 4
 3
 6
 44
 27
 10.0 (0.03–25.6)
 88.0 (76.2–94.4)
 33.3 (12.1–64.6)
 62.0 (50.3–72.3)
Greensboro
 0
 3
 67
 0
 –
 95.7 (88.1–98.5)
 <1 (0–56.2)
 100 (94.6–100)
Greenville
 0
 2
 71
 0
 –
 97.3 (90.6–99.1)
 <1 (0–65.8)
 100 (94.9–100)
MSD Buncombe (Asheville)
 0
 2
 42
 17
 <1 (0–18.4)
 95.4 (84.9–98.7)
 <1 (0–79.3)
 71.2 (58.6–81.1)
North Durham
 0
 1
 6
 0
 –
 85.7 (48.7–97.4)
 <1 (0–79.3)
 100 (61.0–100)
Raleigh 3 2 40 38 7.3 (2.5–19.4) 95.2 (84.2–98.7) 60.0 (23.1–88.2) 51.3 (40.4–62.1)
Raleigh 2 0 4 71 0 – 94.7 (87.1–97.9) <1 (0–49.0) 100 (94.9–100)
Raleigh 3
 0
 3
 75
 0
 –
 96.2 (89.3–98.7)
 <1 (0–56.2)
 100 (95.1–100)
South Durham 0 2 5 0 – 71.4 (35.9–91.8) <1 (0–65.8) 100 (56.6–100)

*Dashes indicate that sensitivity cannot be evaluated in sewersheds with no clinical cases (TP+FN) and PPV cannot be evaluated in sewersheds with no detections (TP+FP). FN, false negative; FP, false positive; MSD, Metropolitan Sewerage District, NPV, negative predictive value; PPV, positive predictive value; TN, true negative; TP, true positive.

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Page created: July 14, 2026
Page updated: September 15, 2026
Page reviewed: September 15, 2026
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