Past, Present and Future of Wastewater-Based Surveillance in Public Health Monitoring

Public Health epidemiology and surveillance are crucial components of disease prevention and health promotion within communities and populations. Epidemiology forms the scientific basis for understanding health trends, and surveillance acts as a tool for continuous monitoring and data-driven decision-making in public health. Wastewater-based surveillance (WBS) involves systematic sampling and testing of untreated wastewater to identify biomarkers such as viruses, pathogens, drugs, and specific diseases. The concept dates to the 1920s and gained significant attention during the Covid-19 pandemic, with global efforts and initiatives to monitor the virus in wastewater. This approach along with data modelling offers real-time tracking of viral presence in the community, serving as an early warning system for potential outbreaks and enabling proactive public health measures. Wastewater surveillance relies on molecular diagnostic methods like Reverse Transcription Polymerase Chain Reaction (RT-PCR) and Next Generation Sequencing (NGS) to detect viral genomes. RT-PCR is commonly used due to its sensitivity and accuracy, whereas NGS enables tracking of emerging variants. While RT-PCR requires reference materials for inter-laboratory comparability, NGS faces challenges with low viral loads and wastewater contaminants. Advanced techniques like hyperplex PCR and metagenomic sequencing offer more comprehensive pathogen detection, enhancing global disease monitoring. Wastewater genomic surveillance holds potential for cost-effective virus detection, especially in low- and middle-income countries. For the future of wastewater-based surveillance in public health monitoring, the aim is to establish a sustainable, global surveillance system integrated with the One-Health approach, connecting human, animal, and ecosystem health at all levels. Key perspectives include interdisciplinary collaboration, inclusion of low and middle-income countries, financial support, capacity building, integration with public health surveillance, multipathogen testing, and ethical guidelines. In the long term, the system is expected to be used in transportation hubs, to monitor surface water resources for various contaminants, and to emphasize modeling efforts with a holistic approach.