Report Says National Wastewater Surveillance Strengthens Public Health Efforts, Future Pandemic Prevention

WASHINGTON - Wastewater surveillance for both prevalent and emerging pathogens can strengthen the nation's infectious disease surveillance system, says a new report from the National Academies of Sciences, Engineering, and Medicine. The report offers recommendations to transition the National Wastewater Surveillance System (NWSS) from its COVID pandemic-era use to a forward-looking system that provides the highest public health value.

Wastewater-based infectious disease surveillance systems detect the presence of biomarkers of infection, such as DNA or RNA, that are shed into a municipal sewer system. These systems can be used to detect changing levels of a pathogen or to identify newly emergent variants in a community. The NWSS was launched by the Centers for Disease Control and Prevention in 2020 in response to the COVID-19 pandemic.

In a Phase 1 report released in early 2023, a study committee examined the usefulness of the NWSS during the COVID-19 pandemic, described the potential value of a robust national wastewater surveillance system beyond COVID-19, and provided recommendations to increase the public health impact of such a system. This Phase 2 report details the technical constraints and opportunities to improve wastewater surveillance for the prevention and control of infectious diseases in the U.S. It recommends improvements in the consistency and quality of national wastewater sampling, testing, and data analysis and identifies research and technology development needs for a national wastewater surveillance system that can serve ongoing and changing public health needs in the U.S.

"Like most aspects of public health, prevention of epidemics and the next pandemic is very likely to be cheaper than the economic and social costs of responding to an infectious disease after it has spread," said Guy Palmer, chair of the committee that wrote the report and Regents Professor of Pathology and Infectious Diseases at Washington State University. "By addressing shortcomings of the current wastewater surveillance system, many of which originated in its rapid development under a pandemic emergency, the public value of wastewater data can be elevated and provide the foundation for more nimble public health responses to ongoing and future threats."

The report provides recommendations for the CDC, states, and localities to improve the NWSS. The recommendations focus on five priority areas:

• Optimize the location of sampling sites to support the sustainability of the NWSS while improving the representativeness of wastewater data. Statistical tools can be used to refine sampling site locations to reduce redundancy and optimize the sampling network. Statistical methods can also be used to extrapolate from participating sites to unsampled areas to improve equity and provide public health information for additional communities.
• Improve wastewater data quality and comparability across localities. The CDC should determine optimal sampling and laboratory analysis methods or performance criteria in collaboration with external researchers.Investment in needed research to accomplish this objective can maximize the public health value of the wastewater information generated.

• Strategically expand the suite of pathogens that are part of routine surveillance. There is clear feasibility and benefit of adding RSV and influenza viruses to the existing wastewater surveillance system that focuses on COVID-19. CDC should carefully evaluate the costs and burden of including additional targets relative to the public health benefit.
• Improve data analysis and interpretation. Wastewater surveillance has created valuable data, and using it to combat infectious diseases can be accelerated through greater data sharing with external researchers. Improved sharing would strengthen the role of wastewater data in forecasting and data visualization to ease interpretability and reduce burdens on state and local health agencies.

• Build capacity for early detection of emerging pathogens, including pathogens with pandemic potential. Sentinel surveillance at locations such as airports and farming communities through wastewater monitoring can powerfully enhance the prospects for identifying the next major threat and intervening early to stop it. Maintaining a national wastewater surveillance system for endemic pathogens allows rapid response to emergencies when they occur.

The report also recommends that once substantial progress has been made in the above priority areas, the CDC should develop an evaluation plan for the NWSS to assess the value and usefulness of information relative to the costs and burdens.

The study - undertaken by the Committee on Community Wastewater-Based Infectious Disease Surveillance - was sponsored by the U.S. Department of Health and Human Services.

The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, engineering, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

SOURCE: National Academies of Sciences, Engineering, and Medicine

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