Wastewater-based Disease Surveillance for Public Health Action (2023) / Chapter Skim
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Early in the COVID-19 pandemic, several municipalities and universities developed wastewater surveillance systems to explore the feasibility and potential public health value of SARS-CoV-2 RNA detection in wastewater. In September 2020, the U.S.
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In this report, which encompasses Phase 1, the committee was tasked to review how wastewater surveillance has been helpful to understand COVID-19 in communities and inform local public health decisions. The committee was also charged to examine the value of applications beyond the current COVID-19 pandemic, describe the characteristics of a robust national wastewater surveillance system, and discuss approaches to increase the public health impact of such a system (see Box 1-4 for the committee's complete Phase 1 statement of task)
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As COVID-19 clinical testing and reported case data became less reliable in recent months due to many factors, including increased at-home testing, wastewater surveillance provided continued information on where the virus was circulating and the degree of exposure risk. Although wastewater surveillance is not currently being used as a standalone method to reliably estimate the number of community infections, SARS-CoV-2 wastewater data have correlated with case data and other conventional public health surveillance 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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The committee identified three steps that CDC could take to ensure that resources expended on wastewater surveillance systems are not distributed inequitably. First, CDC should create a comprehensive outreach program to provide information to selected public health officials and utility personnel in localities that are not currently using wastewater surveillance about the potential benefits of joining the national system.
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Selecting future targets for wastewater surveillance is a challenging endeavor that balances potential health benefits against resource investments and the capabilities of existing technology. CDC would benefit from an independent external advisory panel, with representation from industry, academia, and public health, to provide periodic guidance and input to this process and ensure that the latest advancements
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Predictable funding is also essential to maintain the workforce capacity and institutional knowledge to sustain a well-functioning wastewater surveillance system that is useful to public health agencies and to support an effective system for data management and interpretation for all public health agencies.
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At a federal level, CDC could set expectations and standards of practice that utilities be engaged as full partners, with compensation for their participation and education and data sharing to ensure that the utilities see the value of their contributions. Local public health agencies should work to build relationships with utilities, who can also provide important expertise essential to developing sound sampling designs and accurate data interpretation.
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