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How Wastewater Surveillance Can Serve as a Long-Term Public Health Tool

September 19, 2022
Min Read
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First COVID-19, then monkeypox, and now polio. Communities across the U.S. are constantly grappling with emerging public health challenges and how to appropriately respond via methods such as vaccine distribution, clinical testing, and wastewater surveillance.

The latest update on Monkeypox

The CDC describes monkeypox as a rare disease caused by infection of the monkeypox virus, with symptoms similar to smallpox. As of September 19th, 2022, the CDC reported over 23,000 confirmed cases of monkeypox in the U.S. From late June to late August, daily reported cases in the U.S. have increased from single digits to hundreds. The Secretary of Health and Human Services officially declared the monkeypox outbreak a public health emergency on August 4th, 2022.

To prevent the further spread of the disease, health officials need tools to detect cases and monitor the outbreak. The gold standard for monitoring includes access to widespread rapid clinical testing. However, clinical testing depends on resource availability and voluntary use by patients. Alternatively, wastewater surveillance can be used to anonymously analyze the spread of disease via testing community sewage. Multiple traces of monkeypox have been detected in the San Francisco Bay Area wastewater.

CDC Monkeypox and Orthopoxvirus Cases as of Sept 16 2022

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The latest update on polio

In June of 2022, the CDC, the New York State Department of Health, and local health officials in New York State confirmed a case of polio in New York. The confirmed case sparked several investigative activities, including (CDC):

  • Notifying health care providers
  • Monitoring potentially infections
  • Conducting wastewater testing
  • Assessing vaccination coverage
  • Hosting vaccination clinics/making the vaccine available

Wastewater sampling in Rockland and Orange counties indicated 8% of wastewater samples yielded positive poliovirus tests. According to Dr. Irina Gelman, Commissioner of Health, Orange County, multiple strains of poliovirus exist, indicating the outbreak isn’t contained (NPR).

How wastewater surveillance can support public health response plans now and into the future

Wastewater surveillance is a disease-tracking tool that involves analyzing untreated wastewater for biomarkers. The approach has been used for decades but gained widespread use during the COVID-19 pandemic caused by the SARS-CoV-2 virus. Public health departments across the world employed wastewater testing of SARS-CoV-2 to monitor the spread of the disease.  

Several researchers showed that wastewater data could precede clinical testing by several days, suggesting the approach can provide a crucial early warning system. The approach is useful because it does not rely on voluntary clinical testing and can be used to track the spread of new variants. More recently, wastewater testing is used to monitor other diseases, such as influenza, RSV, monkeypox, and now polio. The Portland Water District in Maine recently announced beginning a similar public health program.

The Sewer Coronavirus Alert Network (SCAN) provides another example, where it measured monkeypox DNA in wastewater solids (primary treatment sludge) from several treatment plants across the U.S. While it is unclear whether testing of wastewater solids will provide an early warning of monkeypox outbreaks, it is currently serving as a secondary dataset to confirm clinical data gathered by public health officials.  

Recent advancements in the testing of the liquid phase of wastewater, such as at UNLV, will open up opportunities to sample at neighborhoods and building locations, which are more amenable to rapid public health action.  

The power of combining wastewater data with other public health data

Public health leaders can combine wastewater surveillance data with clinical data to develop predictive insights and help inform their mitigation strategies to reduce the spread of infectious diseases. Once integrated, advanced analyses and powerful data visualizations allow public health officials to observe trends, rapidly respond to hot spots, and ultimately preserve public health. Centralizing and integrating this data within a secure database offers communities the flexibility to adapt to emerging data needs tomorrow, while still delivering powerful insights today.  

Catch super-spreader events before it's too late

Software tools that automatically integrate and normalize field and laboratory data, monitor trends, and develop reports help lessen overall response time for public health officials and community leaders. Learn more about epiCAST, a cloud-based data analytics platform enabling effective wastewater surveillance program management. Centralize your public health data today to help mitigate emerging outbreaks.  


epicast for wastewater surveillance and analytics
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Written by
Megan Simonian
Events Marketing Coordinator
Megan is a recent Northeastern University graduate and infrastructure industry enthusiast with a passion for reading and writing.

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