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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Wastewater surveillance in the United States has evolved from an emergency response initiative into a valuable component of public health infrastructure. During its first 4 years, the Centers for Disease Control and Prevention’s National Wastewater Surveillance System (NWSS) expanded its national testing coverage, suite of pathogen targets, analytics capabilities, data visualizations, and laboratory methods. Collaborations across public, private, and academic sectors continue to drive progress toward standardization of practices, interpretation of wastewater signals, and translation of wastewater surveillance into public health action. This article describes the evolution of NWSS from late 2020 through 2024, highlighting its integration into public health practice and its demonstrated adaptability and scalability as a surveillance system supporting timely, data-driven decision-making to address community-level public health threats.
Wastewater surveillance has become a valuable component of the United States public health infrastructure since late 2020, when the Centers for Disease Control and Prevention (CDC) launched the National Wastewater Surveillance System (NWSS) to coordinate testing and reporting for SARS-CoV-2 in wastewater ( 1 , 2 ). NWSS is a partnership between state, tribal, local, and territorial public health departments (hereafter referred to as health departments), commercial entities, and academia to track a range of pathogen targets in sewersheds, or the community area contributing wastewater to a sample site. As a relatively new surveillance system, NWSS has quickly transformed from a rapid-response effort into an adaptive surveillance structure that can support long-term infectious disease monitoring. NWSS complements case-based and syndromic surveillance by providing timely insights into infectious disease signals at the community level ( 3 ).
Since 2020, NWSS has expanded its wastewater sampling network across the continental United States and its territories, growing from 295 sites representing ≈12% of the US population in 2020 to >1,800 sites representing ≈45% of the US population in 2024 ( 4 ). During that same period, NWSS broadened its scope from a single-pathogen system tracking only SARS-CoV-2 to one that monitors multiple pathogen targets. In 2022, NWSS added testing for monkeypox virus (MPXV) in response to the 2022 global outbreak and has since expanded to additional targets such as influenza A (and subtypes), influenza B, and respiratory syncytial virus (RSV). That growth has been supported by the One CDC Data Platform (1CDP, formerly DCIPHER), alongside improvements in analytic methods and data visualizations ( 3 , 5 ). The NWSS program has also fostered collaboration across the public and private sector, including with health departments, commercial laboratories, nonprofit entities, and academic institutions to further wastewater surveillance science. This article describes NWSS from its inception through 2024, updating previously published findings ( 4 ), with an emphasis on advances in system coverage, pathogen monitori…