Wastewater pandemic preparedness: Toward an end-to-end pathogen monitoring program

Abstract

Molecular analysis of public wastewater has great potential as a harbinger for community health and health threats. Long-used to monitor the presence of enteric viruses, in particular polio, recent successes of wastewater as a reliable lead indicator for trends in SARS-CoV-2 levels and hospital admissions has generated optimism and emerging evidence that similar science can be applied to other pathogens of pandemic potential (PPPs), especially respiratory viruses and their variants of concern (VOC). However, there are substantial challenges associated with implementation of this ideal, namely that multiple and distinct fields of inquiry must be bridged and coordinated. These include engineering, molecular sciences, temporal-geospatial analytics, epidemiology and medical, and governmental and public health messaging, all of which present their own caveats. Here, we outline a framework for an integrated, state-wide, end-to-end human pathogen monitoring program using wastewater to track viral PPPs.

Keywords: detection; early warning system; epidemiologic; pathogens; public health; virus; wastewater.

Figure 1

Formation of an end-to-end, statewide wastewater viral epidemiology program. Step 1—utility onboarding; Step 2—sample procurement, shipping and intake; Step 3—sample processing and molecular analysis; Step 4—targeted and comprehensive detection with targeted validation; Step 5—analysis; Step 6—positive detection response; Step 7—health department notification, communication to government stakeholders and community data update.

Figure 2

The wastewater detection notification scheme and network. Validated viral detection events of concern are assessed first for whether they are on the DSHS immediate notification list. DSHS as well as other stakeholders (local public health experts, state leaders, and/or utilities) are notified with additional action dependent on the threat of the concern (for example, smallpox vs. influenzae). Additional actions such as consultation with stakeholders and/or a press release may be needed. Viruses of seasonal or endemic nature (influenzae, SARS-CoV-2, RSV) are automatically entered into a real-time trend analysis with user-friendly reports provided on a regular basis (dependent on whether the targeted or agnostic method is being used). Long-term goals include a user-friendly community data set segmented in time, space, and viral species or variant detected.