The detection of monkeypox virus (DNA and virus by isolation) in air samples is novel and detection of monkeypox virus DNA at distances of more than 1♵ m from the patient's bed and a height taller than 2 m supports the theory that virus DNA is suspended in aerosols, skin flakes, or dust. Competent virus has now been retrieved from environmental sampling, including an air sample. Viral DNA has been detected on the PPE of health-care workers and in areas used for the removal of PPE. The available evidence shows widespread contamination in environments occupied by individuals with symptomatic monkeypox. To date, there have been no previous reports of positive air samples or viable virus detected from hospital settings where patients with monkeypox have been managed. Human-to-human transmission of monkeypox virus is believed to be via direct contact, body fluids, fomites, and large respiratory droplets. In non-human primates, there has been proven transmission via aerosol (Zaire strain), albeit using a high quantity of virus. Under laboratory conditions, aerosolised monkeypox virus remained viable for 90 h. The durability of monkeypox virus on surfaces is unknown. A hospital worker in the UK with confirmed monkeypox infection in 2018 was thought to have been exposed to the virus while changing bedding, without wearing PPE (beyond gloves and an apron) as the patient was yet to be diagnosed. Secondary infections in household contacts have, in most reports, ranged between 0% and 10%. Regarding the hospital environment, findings published in June, 2022 from the sampling of surfaces in rooms occupied by individuals with monkeypox in Germany showed detection of virus on most surfaces sampled, including on touch surfaces in an anteroom used for the removal of personal protective equipment (PPE known as doffing). A 2022 paper on environmental sampling in a domestic environment described widespread contamination on various surfaces and showed that competent virus was retrievable in certain positive samples. Our search returned 128 studies, 11 of which were relevant to this topic. Articles describing human-to-human transmission, or the stability of monkeypox virus on surfaces or in air, were also of interest. We selected articles describing environmental sampling to detect monkeypox virus or describing human infection with a potential link to environmental contamination. We searched PubMed for all relevant papers published between (first case of human monkeypox was in 1970) and July 30, 2022, using the keywords “monkeypox”, “contamination”, “environmental”, “surface”, and “airborne”, with no language restrictions. The Lancet Regional Health – Western Pacific.The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.
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