Wastewater-based Disease Surveillance for Public Health Action (2023) / Chapter Skim
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1 Introduction
1 Introduction
Pages 9-24
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public health infrastructure, particularly the challenges to implementing widespread clinical testing, tracking asymptomatic infections, and anticipating community disease outbreaks. During the COVID-19 pandemic, wastewater surveillance1 gained traction as an additional epidemiological tool to monitor trends and anticipate disease incidence in communities.
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infectious disease for an individual person or household; rather, it detects the presence and changing quantities of a pathogen within the larger community. In the United States, 84 percent of households are connected to a wastewater treatment plant (U.S.
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into the wastewater system through feces, urine, saliva, and other sources. Household wastewater is discharged into the sewer system and collected at the inflow to the wastewater treatment plant, where sampling occurs.
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Wastewater surveillance was deployed at several locations across the United States and internationally to forecast and monitor disease outbreaks (see Table 1-1) and was found to be effective in capturing information about both asymptomatic and symptomatic infections as well as in predicting outbreaks (see Chapter 2 for more detail)
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Even though clinical surveillance of acute flaccid paralysis was considered the gold standard for polio surveillance, throughout the latter half of the 20th century, numerous studies reported the use of wastewater surveillance in addressing poliovirus out breaks (Adu et al., 1998; Böttiger and Herrström, 1992; Gershy-Damet et al., 1987; Horstmann et al., 1973; Manor et al., 1999a,b; Marques et al., 1993; Pöyry et al., 1988; Thraenhart et al., 1977; van der Avoort et al., 1995; Zdrazílek et al., 1971)
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. Other urban areas are served by numerous smaller treatment plants; for example, Houston Water operates 39 wastewater treatment plants for its 2.2 million customers.a Thus, as demonstrated in these examples, wastewater surveillance sampling at treatment plant inflow can provide quite different levels of spatial detail.
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INTRODUCTION 15 FIGURE 1-3-1 Map of sewersheds and sub-sewersheds used for SARS-CoV-2 in Jefferson County, Kentucky. NOTE: Triangles are wastewater treatment plants.
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Local Houston, The city collects wastewater samples from the 39 wastewater Programs Texas treatment plants within the city, as well as at lift stations within the sewershed and individual facilities. The city uses the wastewater data, along with other data sources such as individual clinical testing results and vaccination rates, to identify ZIP code-level "hot spots" for targeted public health intervention.
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unless otherwise noted. is the first national-level wastewater disease surveillance system in the United States, and it coordinates with state-, tribal-, local-, and territoriallevel health departments to design and integrate wastewater surveillance data to inform public health decisions.
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A public health, commercial, or academic laboratory partner analyzes the samples, and the public health department interprets the data to identify trends regarding infection prevalence within a community, integrate the wastewater data with other surveillance data, and determine the appropriate public health response. The multidisciplinary nature of a national wastewater surveillance system requires extensive collaboration between and across health departments, testing laboratories, and wastewater utilities.
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.5 An additional $200 million in grants were made available from the ELC Enhancing Detection and Enhancing Detection Expansion program, supported by the Coronavirus Response and Relief Supplemental Appropriations Act of 2021.6 Finally, the NWSS was granted $384 million through the American Rescue Plan,7 starting in FY 2022 for use through 2025. In FY 2022, the NWSS supported wastewater surveillance initiatives in 42 states and 5 cities, with a total of $64 million in funding.
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) , and weekly briefs for federal policy makers.11 The goal of the NWSS is for these data to be interpreted by public health officials and used to inform community health interventions, to raise public awareness of disease transmission within communities, and to track pathogen dynamics across the nation.
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In particular, state, tribal, local, and territorial public health professionals; public utilities; and CDC are reviewing the usefulness of wastewater surveillance to inform public health decisions for SARS-CoV-2 as well as potential applications to other infectious pathogens. The surveillance system is also at a point of transition from an ad hoc collection of willing state and local participants seeking all useful information for local emergency pandemic response to a forward-looking national wastewater surveillance system that serves state, tribal, local, territorial, and national public health objectives simul
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In addition, uncertainty remains around the use of wastewater surveillance to inform public health response, particularly how this form of disease monitoring can contribute to and complement traditional public health surveillance through clinical data and syndromic surveillance. BOX 1-4 Statement of Task Phase 1 An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will review community-level wastewater-based disease surveillance and its potential value toward prevention and control of infectious diseases in the United States.
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The first phase, which is the focus of this report, provides an assessment of the usefulness of current community-level wastewater surveillance in the United States and its potential value for infectious disease beyond COVID-19. As explained in the statement of task, in the context of this study, "community-level" wastewater surveillance includes "sampling wastewater-based disease surveillance.
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Chapter 3 describes a vision for a national wastewater disease surveillance system, including key characteristics of a robust system. Chapter 4 discusses strategies for implementing the committee's vision for a national wastewater-based infectious disease surveillance system beyond COVID-19, discussing future challenges and strategies to collaborate across federal, state, and local jurisdictions.
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