Surveillance of wastewater is an emerging strategy across the US and world to provide an early warning system of the presence of novel and low-frequency pathogens or contaminants within a community. If identified, these pathogens or contaminants can be isolated to the localized area that the sewage was collected from a "sewershed." 

Using Wastewater Surveillance to Detect Community Infection

Based on successes in Europe, the Middle East and parts of Asia, CDC, EPA and other researchers have examined how to sample all or parts of a sewershed and test those samples using qualitative PCR (qPCR) and/or digital PCR (dPCR) to determine the presence and absence of SARS-CoV-2, the virus that causes COVID-19. Next generation sequencing (NGS) can also be performed on a wastewater samples to determine which variant(s) of concern are present. A positive sample can indicate the presence of infected individual(s)prior to them showing symptoms. Public health officials may be able to use that information to test all individuals in the sewershed, as wastewater provides population level data, to determine quarantine or other preventative measures. Wastewater surveillance cannot completely replace clinical testing, but it is additional early information that can help to circumvent unknown viral spreading. In response to recent outbreaks, CDC NWSS is looking towards the use of wastewater surveillance to detect Monkeypox and Polio in vulnerable communities. 

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. If you are interested in joining, please email​. APHL also participates in the health department community of practice, led by CDC, and the utilities community of practice, led by the Water Environment Federation (WEF).
To assist environmental health laboratories as they implement wastewater surveillance in their jurisdictions, APHL, with help from CDC, developed the "SARS-CoV-2 Wastewater Surveillance Testing Guide for Public Health Laboratories.

APHL Resources

Guidance Documents and Tools 

Webinars and APHL Annual Conference Sessions

Lab Matters Articles

Future Targets

As we begin to move away from the pandemic, wastewater surveillance will be used more as a general surveillance tool rather than a pandemic response tool. This type of testing is also useful for other targets of public health concern. Some potential uses include:

  • Anti Microbial Resistance (AMR) genes 

  • Influenza

  • Monkeypox  

  • Norovirus and other enteric diseases

  • Polio

General Resources