Wastewater monitoring can anchor global disease surveillance systems

Aparna Keshaviah, Megan B Diamond, Matthew J Wade, Samuel V Scarpino, Warish Ahmed, Fabian Amman, Olusola Aruna, Andrei Badilla-Aguilar, Itay Bar-Or, Andreas Bergthaler, Julie E Bines, Aaron W Bivins, Alexandria B Boehm, Jean-Martin Brault, Jean-Baptiste Burnet, Joanne R Chapman, Angela Chaudhuri, Ana Maria de Roda Husman, Robert Delatolla, John J DennehyMegan Beth Diamond, Celeste Donato, Erwin Duizer, Abiodun Egwuenu, Oran Erster, Despo Fatta-Kassinos, Aldo Gaggero, Deirdre F Gilpin, Brent J Gilpin, Tyson E Graber, Christopher A Green, Amanda Handley, Rochelle H Holm, Heribert Insam, Marc C Johnson, Rabia Johnson, Davey L Jones, Timothy R Julian, Asha Jyothi, Tamar Kohn, Katrin G Kuhn, Giuseppina La Rosa, Marie Lesenfants, Douglas G Manuel, Patrick M D'Aoust, Rudolf Markt, John W McGrath, Gertjan Medema, Christine L Moe, Indah Kartika Murni, Humood Naser, Colleen C Naughton, Leslie Ogorzaly, Vicka Oktaria, Christoph Ort, Popi Karaolia, Ekta H Patel, Steve Paterson, Mahbubur Rahman, Pablo Rivera-Navarro, Alex Robinson, Monica C Santa-Maria, Heike Schmitt, Theodore Smith, Lauren B Stadler, Jorgen Stassijns, Alberta Stenico, Renee A Street, Elisabetta Suffredini, Zachary Susswein, Monica Trujillo, Marlene K Wolfe, Habib Yakubu, Maria Ines Zanoli Sato

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To inform the development of global wastewater monitoring systems, we surveyed programmes in 43 countries. Most programmes monitored predominantly urban populations. In high-income countries (HICs), composite sampling at centralised treatment plants was most common, whereas grab sampling from surface waters, open drains, and pit latrines was more typical in low-income and middle-income countries (LMICs). Almost all programmes analysed samples in-country, with an average processing time of 2·3 days in HICs and 4·5 days in LMICs. Whereas 59% of HICs regularly monitored wastewater for SARS-CoV-2 variants, only 13% of LMICs did so. Most programmes share their wastewater data internally, with partnering organisations, but not publicly. Our findings show the richness of the existing wastewater monitoring ecosystem. With additional leadership, funding, and implementation frameworks, thousands of individual wastewater initiatives can coalesce into an integrated, sustainable network for disease surveillance?one that minimises the risk of overlooking future global health threats.
Original languageEnglish
Pages (from-to)e976-e981
JournalThe Lancet Global Health
Issue number6
Early online date17 May 2023
Publication statusPublished - Jun 2023

Bibliographical note

doi: 10.1016/S2214-109X(23)00170-5


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