A global aircraft-based wastewater genomic surveillance network for early warning of future pandemics

Abstract

International airports can have a key role in screening, detecting, and mitigating cross-border transmission of SARS-CoV-2 and potentially other infectious diseases. With aircraft passengers representing a subpopulation of a country or region, aircraft-based wastewater surveillance can be a promising approach to effectively identifying emerging viruses, tracing their evolution, and mapping global spread with international flights. Therefore, we propose the development of a global aircraft-based wastewater genomic surveillance network, with the busiest international airports as central nodes and continuing air travel journeys as vectors. This surveillance programme requires routinely collecting aircraft wastewater samples for microbiological analysis and sequencing and linking the resulting data with associated international air traffic information. With the creation of a strong international alliance between the airline industry and health authorities, this surveillance network will potentially complement public health systems with a true early warning ability to inform decision making for new variants and future global health risks.

Figure 1

Spread of SARS-CoV-2 variants across five continents and flight routes from the busiest ten international airports in 2021 The top ten busiest airports worldwide in 2021 were published by the Airports Council International. The ranking was based on international passenger traffic. Flight route data were obtained from OpenFlights. Data for SARS-CoV-2 variants were obtained from GISAID, including variants of concern (alpha [B.1.1.7], beta [B.1.351], gamma [P.1], delta [B.1.617.2 and AY], and omicron [B.1.1.529 and BA.]), previous variants of interest (lambda [C.37] and mu [B.1.621 and B.1.621.1]), and variants under monitoring (GH/490R [B.1.640]). DXB=Dubai International Airport, Dubai, United Arab Emirates. ISL=Atatürk International Airport, Istanbul, Türkiye. AMS=Amsterdam Schipol Airport, Amsterdam, Netherlands. FRA=Frankfurt Airport, Frankfurt, Germany. CDG=Paris Charles de Gaulle Airport, Paris, France. DOH=Hamad International Airport, Doha, Qatar. LHR=London Heathrow, London, UK. AYT=Antalya Airport, Antalya, Türkiye. MAD=Adolfo Suárez Madrid–Barajas Airport, Madrid, Spain. CUN=Cancun International Airport, Cancun, Mexico.

Figure 2

Flow diagram of the proposed global aircraft-based wastewater genomic surveillance network