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Environmental surface and air contamination of MPXV in household and healthcare settings: a systematic review of detection and viability
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DOI：10.1186/s12879-026-13879-2.png)
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Abstract
En 中文
Mpox virus (MPXV) transmission primarily occurs through direct contact with infected skin lesions or body fluids. However, the 2022 and 2024 global outbreaks renewed concerns regarding the potential contribution of contaminated surfaces and air to transmission dynamics. This systematic review aimed to synthesize current evidence on environmental surface and air contamination of MPXV in household and healthcare settings. A systematic search of the literature was conducted to identify studies reporting environmental surface or air sampling for MPXV in clinical or household settings. Data were extracted on sampling methods, timing, detection metrics, and viral culture results. Surfaces were categorized into functional groups to allow cross-study comparison, and median Ct values were calculated when sample-level data were available. Healthcare worker (HCW) exposure and infection outcomes were also descriptively analysed. Twenty-three studies met the inclusion criteria. Across 391 direct patient-contact surfaces with analysable molecular data, 73.1% were PCR-positive for MPXV DNA. Among samples reporting Ct values, the median Ct was 32.2 (range: 16.1–39.0), while quantitative viral loads ranged from 0.301 to 5.38 log10 copies/cm². Porous materials, particularly bedding and soft surfaces, demonstrated lower median Ct values compared to non-porous surfaces. Air sampling showed PCR positivity in over half of eligible samples, although viral loads were generally low. Viral culture was performed in a subset of studies, with viable virus recovered in a minority of samples, predominantly from surfaces with lower Ct values. Among 543 exposed healthcare workers, only 4 became infected without direct contact or sharps injury, despite documented environmental contamination in several settings. No additional HCW infections occurred during follow-up in most studies. Environmental contamination with MPXV DNA is frequently detectable in both household and healthcare settings. However, detection of viral DNA does not consistently correlate with viral viability, and confirmed occupational transmission among healthcare workers remains rare. Current evidence supports the predominance of direct contact transmission, while environmental contamination may represent a contextual amplification factor under specific conditions. Further studies incorporating standardized sampling methods and culture-based viability assessments are needed to better define the clinical relevance of environmental MPXV contamination.
Keywords:
Monkeypox virus
MPXV
Environmental contamination
Surface contamination
Air contamination
Healthcare workers
Infection control
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