Wastewater surveillance for public health

Abstract

Dating back to the origins of modern epidemiology, wastewater surveillance has predominantly been used to track pathogens spread by fecal-oral transmission such as those that cause cholera and polio. However, more than just these “enteric” pathogens are shed via the gut, as highlighted by the success of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater surveillance (1, 2), recent work on tracking influenza virus (3) and monkeypox virus (4), and observations of extensive pathogen diversity in stool (5, 6). Wastewater is now a core component of infectious disease monitoring, providing a variant-specific, community-representative picture of public health trends that captures previously undetected spread and pathogen transmission links. Building on recent laboratory and analytical advances to identify the diverse pathogens present in sewage will be essential to ongoing efforts to understand disease risks and will transform infectious disease surveillance.