The COVID-19 pandemic spurred a rapid expansion of wastewater-based infectious disease surveillance systems to monitor and anticipate disease trends in communities.The Centers for Disease Control and Prevention (CDC) launched the National Wastewater Surveillance System in September 2020 to help coordinate and build upon those efforts. Produced at the request of CDC, this report reviews the usefulness of community-level wastewater surveillance during the pandemic and assesses its potential value for control and prevention of infectious diseases beyond COVID-19.

Wastewater-based Disease Surveillance for Public Health Action concludes that wastewater surveillance is and will continue to be a valuable component of infectious disease management. This report presents a vision for a national wastewater surveillance system that would track multiple pathogens simultaneously and pivot quickly to detect emerging pathogens, and it offers recommendations to ensure that the system is flexible, equitable, and economically sustainable for informing public health actions. The report also recommends approaches to address ethical and privacy concerns and develop a more representative wastewater surveillance system. Predictable and sustained federal funding as well as ongoing coordination and collaboration among many partners will be critical to the effectiveness of efforts moving forward.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON COMMUNITY WASTEWATER-BASED INFECTIOUS DISEASE SURVEILLANCE
• Reviewers
• Preface
• Acronyms
• Summary
  • WASTEWATER SURVEILLANCE FOR COVID-19
  • VISION FOR A NATIONAL WASTEWATER SURVEILLANCE SYSTEM
  • STRATEGIES FOR ACHIEVING THE VISION
• 1. Introduction
  • DEVELOPMENT OF THE NATIONAL WASTEWATER SURVEILLANCE SYSTEM
  • MOTIVATION FOR THE STUDY
  • REPORT STRUCTURE
• 2. Wastewater Surveillance for COVID-19
  • VALUE FOR UNDERSTANDING COVID-19 IN COMMUNITIES
  • USE IN INFORMING PUBLIC HEALTH ACTIONS
  • INNOVATION IN RESPONSE TO IMPLEMENTATION CHALLENGES
  • CONCLUSIONS
• 3. Vision for National Wastewater Surveillance
  • BENEFITS OF SUSTAINED NATIONAL WASTEWATER SURVEILLANCE
  • KEY CHARACTERISTICS OF A NATIONAL WASTEWATER SURVEILLANCE SYSTEM
  • A FRAMEWORK FOR IDENTIFYING CANDIDATE PATHOGENS FOR WASTEWATER SURVEILLANCE
  • ILLUSTRATIVE APPLICATIONS OF CRITERIA
  • VISION FOR AN EFFECTIVE FRAMEWORK FOR DETERMINING TEMPORAL AND SPATIAL RESOLUTION
  • CONCLUSIONS AND RECOMMENDATIONS
• 4. Strategies for Achieving the Vision and Increasing the Public Health Impact of National Wastewater Surveillance
  • A SYSTEMATIC AND DYNAMIC PROCESS FOR EVALUATING TARGETS FOR WASTEWATER SURVEILLANCE
  • PUBLIC ACCEPTANCE: LEGAL AND ETHICAL CONSIDERATIONS
  • ASSURING DATA QUALITY AND ACTIONABILITY
  • BUILDING BROAD AND SUSTAINABLE CAPACITY
  • ACHIEVING INTEGRATION AND COLLABORATION
  • CONCLUSIONS AND RECOMMENDATIONS
• References
• Appendix A. Committee Members and Staff Biographical Sketches
• Appendix B. Board Rosters

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2023. Wastewater-based Disease Surveillance for Public Health Action. Washington, DC: The National Academies Press. https//doi.org/10.17226/26767.

Digital Object Identifier: https://doi.org/10.17226/26767

Library of Congress Control Number: 2023934388

This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Printed in the United States of America.