Wastewater-based Disease Surveillance for Public Health Action (2023) / Chapter Skim
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At CDC's request, the National Academies of Sciences, Engineering, and Medicine appointed a committee to review the current usefulness of community-level wastewater surveillance and its potential value for control and prevention of infectious diseases beyond the first 2 years of the COVID-19 pandemic. For the purpose of this study, community-level wastewater-based disease surveillance implies sampling at wastewater treat 1
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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, the committee envisions a national wastewater surveillance system that is flexible, equitable, sustainable, integrated, and actionable, and recommends criteria and a process for adapting the NWSS to additional microbial threats.
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Depending on a number of factors, including wastewater sampling frequency, the time required for sample transport and analysis, and the time required for data reporting, wastewater SARS-CoV-2 viral trends have the potential to be reported more quickly or along a more consistent time frame than conventional disease surveillance reporting. 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.
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Although the NWSS supports both local and national public health decision making, a sustainable national wastewater surveillance program may not serve every locality's objectives but should allow for locally funded initiatives, such as pilot surveillance of a pathogen of emerging regional concern. When evaluating potential targets for future wastewater surveillance, CDC should consider three criteria: (1)
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Finally, it is critical that the value of wastewater surveillance information for a given pathogen be considered in the context of the broader universe of surveillance approaches so as to maximize the use of resources to inform public health action (e.g., allocation of clinical or public health resources)
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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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