North Carolina health officials have sounded the alarm after Clade I mpoxvirus particles were detected in wastewater samples collected in Greenville. This is the first time the rare Clade I strain has been identified in the state, sparking concerns over potential undetected or unreported infections in the region.
Virus Detected in Routine Wastewater Testing
According to the North Carolina Department of Health and Human Services (NCDHHS), the virus was found during routine surveillance by the North Carolina Wastewater Monitoring Network. Samples collected on March 25, March 28, and April 8 from a wastewater treatment plant in Greenville tested positive for Clade I mpox.
No confirmed human cases of Clade I mpox have been reported in North Carolina to date. However, the presence of viral particles suggests someone infected with the strain may have been in the area.
“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 Dr. Dev Sangvai, Secretary of NCDHHS. “We encourage healthcare providers to be on the lookout for mpox cases and people who are at higher risk to protect themselves by getting vaccinated.”
What is Clade I Mpox?
Formerly known as monkeypox, mpox is a contagious viral illness characterized by a painful or itchy rash that may appear on the face, genitals, hands, or feet. Some individuals also experience flu-like symptoms, including fever, chills, fatigue, and swollen lymph nodes.
Mpox has two genetic variants: Clade I and Clade II. While Clade II has been predominant in global outbreaks since 2022, Clade I is typically found in Central and Eastern Africa and spreads mainly through heterosexual contact. In the U.S., only four Clade I cases have been confirmed between November 2024 and February 2025.
How Wastewater Monitoring Works
The North Carolina Wastewater Monitoring Network, launched in 2021, helps detect emerging viral threats by analyzing samples from 35 wastewater treatment plants across the state. The system has proven effective in monitoring COVID-19, influenza, RSV, and now mpox — offering early warnings of potential public health crises.
Public Health Recommendations
Though the current risk to the general public is low, health officials urge residents to stay aware and take precautions:
Monitor Symptoms: Watch for rash or flu-like symptoms.
Seek Medical Help: If symptoms appear or exposure is suspected, contact a healthcare provider or local health department.
Vaccinate: Mpox vaccines are available and effective against both Clade I and II. Visit the NCDHHS mpox page for vaccination info.
Healthcare providers are also asked to consider mpox in symptomatic patients and to inquire about recent travel, particularly to areas with Clade I outbreaks. Suspected cases should be reported immediately by calling 919-733-3419, the NCDHHS Division of Public Health 24/7 epidemiologist line.
