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We analyzed 192 responses from a 2024 survey of Emerging Infections Network members in the United States regarding how wastewater surveillance can affect clinical practice. Four themes emerged: situational awareness, patient counseling, infection control, and diagnostic support. Enhanced collaboration between public health officials and clinicians might optimize utility of such surveillance in clinical practice.
Although wastewater surveillance (WWS) ( 1 ) has a role in outbreak detection ( 2 – 4 ), integration of WWS data into clinical practice remains limited ( 5 ). Little is known about how infectious disease clinicians perceive WWS ( 6 ). The Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America’s Emerging Infections Network (EIN) ( https://ein.idsociety.org ), a sentinel network of infectious disease physicians and other infectious disease specialists, surveyed EIN member-clinicians in 2024 to generate hypotheses about knowledge of, attitudes toward, and use of WWS data ( 5 , 7 ) Our previously published quantitative results revealed 56% of EIN clinicians did not review WWS data regularly, 22% of respondents reviewed it regularly, and 22% were not aware of WWS data ( 5 ). To complement those previous findings, we present an in-depth analysis of qualitative data from the same survey.
During February–March 2024, we distributed a 9-question, cross-sectional, voluntary internet survey to EIN members. We followed applicable reporting guidelines from The Checklist for Reporting Results of Internet E-Surveys and Standards for Reporting Qualitative Research ( 8 ). We focused on this open-ended question: “Please provide any specific example(s) of how wastewater surveillance has affected/could affect your clinical practice.” Of 1,809 EIN members, 448 (25%) responded to the survey. Of those who responded, 192 (40%) provided free-text comments about clinical impact, with 178 describing how WWS does or could affect their clinical practice and 14 indicating WWS has no affect on their clinical practice. Using content analysis, analysts iteratively reviewed the 192 responses using an inductive approach, noting multiple response topics. Analysts then coded responses, identified potential themes that aligned with responses, and selected representative quotations from a password-protected file. We reviewed codes and themes and refined them through team discussions to ensure consistency in interpretation. The CDC’s National Center for Emerging and Zoonotic Infectious Diseases Human Subjects Advisor reviewed this activity and deemed it nonresearch per applicable federal law and CDC policy.
Figure . Wastewater surveillance information utilization inferred from an investigation into the implications of wastewater surveillance for clinical care among infectious disease physicians, United States, 2024. PPE, personal protective equipment.
We compiled key themes based on survey responses ( Figure ). Of 192 responses, approximately half (47%, n = 91) involved situational awareness and early warning. Respondents stated WWS can help to “i…