A-Z Index × Submit A-Z Index × Submit A-Z Index Search Dropdown × Submit Facebook Twitter LinkedIn Syndicate Emerging Infectious Disease journal ISSN: 1080-6059 Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
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In 2020, the Centers for Disease Control and Prevention (CDC) established the National Wastewater Surveillance System to detect and quantify SARS-CoV-2 RNA through wastewater in the United States. Subsequently, wastewater surveillance for infectious diseases expanded dramatically from independent, local efforts into a coordinated national system ( 1 ). This supplemental issue of Emerging Infectious Diseases describes the substantial progress during the first 5 years of the National Wastewater Surveillance System, including the dramatic growth of wastewater surveillance epidemiology and the increasing public health applications of wastewater surveillance for infectious diseases. Innovation is occurring in multiple sectors, including frontline health departments, which is reflected in the supplement article authorship. Wastewater surveillance has quickly developed into a valuable tool for responding to infectious disease threats.
Wastewater surveillance is unique in that it does not depend on whether persons have symptoms, have access to healthcare, visit a provider, or have a clinical diagnostic test performed. As such, it can fill gaps in other surveillance systems, most of which are reliant on clinical diagnostic tests being performed and reported to public health. Wastewater surveillance also can act as an early warning system and detect small changes in community transmission of infectious diseases, helping public health agencies take action to prevent further infections.
Wastewater surveillance is funded by CDC but relies on a multitude of partners, including academic researchers, commercial laboratories, community stakeholders, wastewater operators and engineers, healthcare professionals, and public health professionals, as seen throughout the articles in this supplement. Key to jurisdictional involvement are the Wastewater Monitoring Centers of Excellence, regional leaders who foster innovation, develop and conduct training, and provide technical assistance to jurisdictions. The 6 Centers of Excellence are led by public health departments through a collaborative partnership with academic and utility partners in California, Colorado, Houston (Texas), New York, North Carolina, and Wisconsin ( 1 ).
This network of partners (public health, academia, and utilities) is necessary to navigate the complex process of operationalizing wastewater surveillance and making it useful for public health. The wastewater surveillance process involves collecting untreated wastewater from a sewershed, often as it flows into a wastewater treatment plant. Wastewater samples are typically collected by wastewater treatment plant operators and sent to laboratories for testing, which includes sample preparation and concentration and extraction and quantification of viral genetic material, most commonly using reverse transcription digital PCR or reverse transcription droplet digital PCR. Isolates can be further sequenced to compare with clinical sequences and elucidate the spread of variants. Several sequence-based detection approaches (e.g., hybrid capture or shotgun metagenomi…