Wastewater surveillance has been used for decades outside the United States to detect targets of public health concern but gained traction in the US in 2020 as a surveillance system for SARS-CoV-2 during the COVID-19 pandemic. Health departments and laboratories are now extending their reach to other targets of public health concern, such as influenza (including H5), respiratory syncytial virus, mpox, anti-microbial resistant genes, polio and more.
Testing wastewater can be used as a public health surveillance tool for the 75% of the US population whose sanitary sewage is treated by municipal wastewater systems. Targets of interest can be carried via feces, bodily fluids and skin into the sewer lines from which a sample is collected prior to utility treatment. The sample is then extracted, concentrated and analyzed at a laboratory. Results from laboratory analysis can provide community insight as to whether a target of interest is present, increasing or decreasing in concentration, or genetically changing. Wastewater surveillance complements clinical data through passive, population-level capture of symptomatic, asymptomatic and non-health care seeking individuals' data and can act as an early warning system.
In response to the COVID-19 pandemic, CDC developed the National Wastewater Surveillance System (NWSS) to allow nationwide public health infrastructure to test wastewater for targets of public health concern.
Learn more or email
NWSS@cdc.gov with questions.
APHL Wastewater Surveillance Efforts
APHL has created a wastewater surveillance community of practice to provide laboratory scientists a forum to discuss best practices, ask questions and hear from colleagues and federal partners on the subject. Participation in the community of practice is limited to state, local, territorial and tribal public health laboratories performing or interested in this testing and their partners. The group meets regularly on the second Monday of the month from 1:00–2:00 pm ET. If you meet these qualifications and are interested in joining, please
create an APHL account and email Erin Morin, specialist, Environmental Health.
APHL also hosts a wastewater surveillance technical user group that offers laboratories newer to wastewater surveillance a smaller platform to discuss successes, challenges and to ask questions of their peers. The group meets regularly on the fourth Monday of the month from 3:00–4:00 pm ET. If you are interested in joining, please email
Erin Morin, specialist, Environmental Health.
APHL participates in the health department community of practice, led by CDC, and the utilities community of practice, led by the Water Environment Federation (WEF).
NWSS Centers of Excellence
The
NWSS Centers of Excellence provide leadership, technical assistance and coordination to their specific regions.
APHL Resources
Survey Data Dashboard
APHL conducts a bi-annual national survey to characterize laboratory capability and capacity. The results outlined in the dashboard below provide a metric for laboratories to measure against as they continue to grow and hone their methods. This dashboard can also be used by NWSS and APHL's NWSS Laboratory Community of Practice to understand the overall wastewater surveillance landscape and to identify successes, challenges and resource needs.
APHL invited 104 state, local and territorial public health, university, utility and private laboratories to participate in our 2025 Wastewater Surveillance Survey between June 30 — September 30, 2025. If laboratories contracted out testing, we also sent the survey to that laboratory to get a more holistic picture of testing. This added six laboratories, bringing the total to 110 invited laboratories with an overall response rate of 95% (105/110). The non-responders were non-APHL member laboratories.
All 50 states and the District of Columbia were represented by at least one state laboratory response. Laboratories were designated as a state, local or territorial public health, wastewater utility or university laboratory based on their answers to Question 1. For the purpose of this survey, Washington DC was categorized as a state. Respondents were routed to different questions based upon their testing status and they were not required to answer all questions.
View the
2023 Survey Report.