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The first sign of a new disease reaching the United States might not be someone showing up at a doctor’s office. It might appear in a sample of sewage. CDC’s National Wastewater Surveillance System (NWSS) started testing for COVID-19 in 2020. When mpox began to spread globally in 2022, CDC expanded wastewater surveillance to look for mpox. And now, with an outbreak of a different, more severe type of mpox causing a large outbreak in the Democratic Republic of the Congo (DRC), CDC has begun using the same