Mainstreaming Wastewater Surveillance for Infectious Disease

This perspective outlines the evolution of wastewater surveillance from a pandemic-era innovation into a foundational tool for infectious disease monitoring. It highlights how SARS-CoV-2 RNA fragments in sewage provided early epidemiological signals, helping guide public health actions, resource distribution, and variant tracking. Building on this success, a National Academies committee recommended a sustainable, equitable national surveillance framework. The article discusses three key challenges: equity (ensuring coverage beyond sewered areas), timeliness (rapid sample-to-data turnaround and integration with other sources), and selectivity (prioritizing pathogens with meaningful public health impact and reliable wastewater detectability). It calls for increased federal investment, streamlined data portals, expanded lab capacity, and community engagement to overcome technical and ideological obstacles. Promising future targets include influenza, enterovirus D68, and antimicrobial resistance genes.

This perspective outlines the evolution of wastewater surveillance from a pandemic-era innovation into a foundational tool for infectious disease monitoring. It highlights how SARS-CoV-2 RNA fragments in sewage provided early epidemiological signals, helping guide public health actions, resource distribution, and variant tracking. Building on this success, a National Academies committee recommended a sustainable, equitable national surveillance framework. The article discusses three key challenges: equity (ensuring coverage beyond sewered areas), timeliness (rapid sample-to-data turnaround and integration with other sources), and selectivity (prioritizing pathogens with meaningful public health impact and reliable wastewater detectability). It calls for increased federal investment, streamlined data portals, expanded lab capacity, and community engagement to overcome technical and ideological obstacles. Promising future targets include influenza, enterovirus D68, and antimicrobial resistance genes.