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Wastewater-based surveillance (WBS) has emerged as a valuable tool for public health, allowing a greater understanding of disease prevalence in communities. With historical significance in monitoring polio transmission,1 WBS gained further prominence in 2020 by enhancing the population-level monitoring of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) trends.2,3 Since then, WBS has been used to track diseases such as influenza,4 respiratory syncytial virus,5 norovirus,6 and mpox. The global implementation of WBS signifies its movement from a research initiative to a staple public health tool, which is especially critical for virus monitoring. However, the diverse methodologies adopted for WBS present challenges. Although each method may address specific stakeholder needs, the lack of standardized reporting guidelines and external validation limits the scope and utility of the data.
A key advantage of WBS is that it enables public health authorities at the state and federal levels to determine where to allocate resources, ideally before a wider spread outbreak. Data aggregation is possible only when metrics such as target concentration and recovery are reported in the same concentrations and with similar driving calculations. This concern is amplified when data from a variety of methods are aggregated at a state, national, or global scale. Therefore, our objective is to promote standardized reporting guidelines in WBS as a critical part of a public health framework.
PROVIDING REAL-TIME ACTIONABLE DATA
WBS provides real-time data on targets (chemical or microbial) to support clinicians, public health response, and the public in general. It can provide an early warning for diseases, as individuals can begin shedding pathogens such as viral particles and microbial cells when they are asymptomatic or presymptomatic.7,8 It can also provide insight into the presence and transmission of an infection. Historically, WBS has most prominently been implemented for monitoring polio transmission.1 WBS for SARS-CoV-2 monitoring during the COVID-19 pandemic provided a similar complementary framework for monitoring community disease prevalence when clinical testing was not yet widely available.2
Genomic sequencing of target pathogens in wastewater has also proven useful for tracking emerging viral variants of concern and for providing clinicians and public health organizations with information on variants circulating in their community.9 Furthermore, WBS has improved the ability to develop seasonal viral models for a community. Seasonal models based on clinical data are...