Mpox detected in NC wastewater, health officials issue alert
April 22, 2025
North Carolina health officials are urging vigilance following the detection of Clade I mpox virus in wastewater samples from Greenville—the first such detection in the state. While no confirmed cases have been reported, the North Carolina Department of Health and Human Services warns that this could signal undiagnosed infections. Wastewater surveillance is an early-warning tool, and Clade I is a more severe strain linked to outbreaks in Central and Eastern Africa. Although public risk remains low, providers are advised to monitor symptoms and assess travel history. Funding for wastewater monitoring remains uncertain, posing a challenge for ongoing viral detection efforts.
North Carolina has entered a critical period of mpox surveillance following the detection of Clade I mpox virus particles in wastewater samples from Greenville, marking the first such detection in the state. Though no confirmed clinical cases have emerged, the North Carolina Department of Health and Human Services (NCDHHS) is urging both residents and healthcare providers to remain alert. The wastewater samples—collected in late March and early April—suggest there may have been an undiagnosed or unreported infection in the community.
Clade I mpox is the more virulent of the two known strains and has been driving a major outbreak in Central and Eastern Africa. In contrast to the 2022 U.S. outbreak, which was largely caused by Clade II and spread among men who have sex with men, Clade I has shown different transmission patterns, including spread through heterosexual contact and household exposure, including to children. Only four cases of Clade I mpox have been documented in the U.S. to date, all travel-related.
NCDHHS emphasized that wastewater surveillance is a powerful early-warning system, but also cautioned that recent federal budget cuts may threaten its continuity. Dr. Emma Doran of NCDHHS noted the state’s monitoring system is among the most advanced in the country, underscoring the importance of sustained investment in public health infrastructure.
Vaccination remains a key preventive measure, and vaccines effective against both clades are available. Health officials are asking residents to be aware of symptoms—especially characteristic rashes or flu-like illness—and to consult a healthcare provider if exposed or symptomatic.
As viral surveillance continues, North Carolina’s proactive stance demonstrates the value of early detection, community engagement, and health system readiness in the face of emerging infectious threats.