Wastewater-based Disease Surveillance for Public Health Action (2023) / Chapter Skim
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The pandemic spurred tremendous innovation and technological advances in wastewater surveillance, and ongoing knowledge development can help address gaps and improve analytical methods and data interpretation, not only for COVID-19 but also for newly emergent and re-emerging infectious diseases. Looking forward, PREPUBLICATION COPY 1
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Wastewater surveillance also provides comprehensive information on the relative proportions of known variants, and genome sequencing of wastewater samples is an effective strategy to screen for emerging variants among a large contributing population, thus providing information in advance of clinical testing data. The emergency response to the COVID-19 pandemic spurred innovation and rapid development and implementation of wastewater surveillance; the challenge is now to unify sampling design, analytical methods, and data interpretation to create a truly PREPUBLICATION COPY
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VISION FOR A NATIONAL WASTEWATER SURVEILLANCE SYSTEM Wastewater surveillance is and will continue to be a valuable component of the nation's strategy to manage infectious disease outbreaks, including continued surveillance of SARS-CoV-2 variants, resurgences of known pathogens, and newly emergent pathogens. The emergency establishment of wastewater surveillance has proven its value, and the efforts at local and national scales to establish the NWSS provide a solid basis for expanded applications.
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, CDC should assess whether tools can be used to extrapolate data from monitored regions to estimate disease burden in areas without wastewater surveillance. CDC and local health departments should also maintain robust infectious disease surveillance programs using other sources of data on disease trends and provide public education about how to interpret wastewater data alongside other indicators.
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The ethics committee, which could be modeled after existing data use committees, should create a formal process for executing data use agreements to help address privacy concerns and alleviate burdens in managing data sharing at a local level. Furthermore, if the prospects for identifying individuals in wastewater data strengthen over time, or if any agency or private-sector organization expresses interest in using wastewater data for purposes other than infectious disease surveillance, this body should re-evaluate the balance of health benefits versus risks associated with data sharing and any proposed expansions in data collection and data linkage.
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Close coordination among public health agencies, analytical laboratories, and wastewater utilities is essential to generate reliable data and support appropriate data interpretation and use. CDC's Communities of Practice for wastewater utilities, laboratory personnel, and public health practitioners provide valuable support for coordination within each of these fields, and CDC can work with these communities to establish expectations for coordination and collaboration with other agencies.
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