Wastewater surveillance of pathogens can inform public health responses

how can data from wastewater complement clinical surveillance

provide a comprehensive view of infection burden and transmission

wastewater monitoring

collection of pooled samples from sewage systems

community-level surveillance

sewers can aggregate human waste into centralized locations

solutions for communities without centralized sewage collection

sampling at localized scales

benefits of localized sampling

insight into pathogenic viruses, bacteria, and protozoa present in community

what are strong candidates for wastewater monitoring

pathogens that are stable in wastewater or shed in fecal material or urine

what types of diseases should be prioritized in wastewater-monitoring programs

diseases that are under-reported under traditional systems and lead to widespread poor health outcomes, diseases with inadequate or inaccessible diagnostic tests

what are examples of diseases should be prioritized in wastewater-monitoring programs

diseases with nonspecific symptoms or symptoms that are not cared for until they are serious, including polio, influenza, and gastroenteritis

what are the promising biomarkers and chemicals that can be measured in sewage to assess health and well-being

viruses and antimicrobial-resistant pathogens

what are common applications of wastewater surveillance

community use of illicit and therapeutic drugs, monitoring consumption of every day compounds, exposure to environmental contaminants

what are trends in wastewater concentrations of SARS-CoV-2 predictive of

clinical case counts

what is the value of wastewater surveillance in the context of at-home diagnostic testing

it can provide critical lead time for making decisions about resources and prevention

what are drawbacks of wastewater-monitoring practices

more work in needed to reliably distinguish signal from noise in biomarker concentrations, lack of consensus on monitoring techniques, how and if data should be standardized, how to integrate data with existing data sources, expanding capacity in rural and unsewered settings

methods used to track novel COVID variants

RT-PCR and NGS

RT-PCR

reverse transcription-polymerase chain reaction

NGS

next-generation genomic sequencing

how did RT-PCR impact the global pandemic

made full genome sequences public through their assays

how has RT-PCR been used in wastewater testing

detects SARS-CoV-2 variants in wastewater

how has NGS been used in wastewater

indicates relative abundance of viral mutations in wastewater; can provide information on viral mutations across many different infections

at what stages are NGS and PCR are respectively deployed

NGS at sentinel sites for novel variants and PCR for more routine testing

what are obstacles to acceptance of wastewater monitoring

dependence on clinical sequences for novel variant identification; shift of labs away from long-term wastewater-sequencing research

what are the consequences of missing wastewater information

impeded ability to detect outbreaks

what is the next phase for wastewater monitoring

multi-pathogen detection and dedicated wasteater monitoring

what are the prerequisites for successful wastewater-monitoring programs

funding, lab testing supplies and personell, risk metrics and communicating risk, community engagement

what is the wastewater monitoring pathway

pathogens shed in human excreta → wastewater is sampled from collection site → pathogen genetic material is amplified → specific pathogen and variant are detected → public health reporting