Wastewater Surveillance

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 1-2 pm ET. If you meet these qualifications and are interested in joining, please create an APHL account and email erin.morin@aphl.org.

 APHL also hosts a wastewater surveillance technical user group that offers laboratories newer to wastewater surveillance a smaller platform to discuss successes, challenges, and ask questions of their peers. The group meets regularly on the fourth Monday of the month from 3-4 pm ET. If you are interested in joining, please email erin.morin@aphl.org.

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.

• California Department of Public Health

• Colorado Department of Public Health and Environment

• Houston Health Department

• North Carolina State Public Health Laboratory

• New York State Department of Health – Wadsworth Center

• Wisconsin State Laboratory of Hygiene

APHL Resources

Guidance Documents and Tools   

• APHL's Wastewater Surveillance protocols.io site 

• This workspace provides a collection of wastewater surveillance protocols for NWSS laboratories to share, reference, and discuss. If you would like to be added to the site to contribute documents and discuss protocols with other members, please email erin.morin@aphl.org. 

• APHL guidance document: SARS-CoV-2 Wastewater Surveillance Testing Guide for Public Health Laboratories  

• National Trends in Wastewater Surveillance: 2023 Survey Report

• CDC Epidemiology and Laboratory Capacity (ELC) Funding Application Tools   
  

• Budget Period 2 – March, 2025
  

• APHL's Public Health Pricing List provides discounted and package deals on WWS, environmental microbiology and other laboratory equipment and supplies. Please let us know if there are additional vendors you would like us to approach for offerings.  

APHL Webinars

• November 2020 webinar: SARS-CoV-2 Wastewater Surveillance: An Introduction for Public Health Laboratories 

• October 2023 Ceres Nanoscience webinar: I Need to Test More Samples! How Can I Improve my Wastewater-Based Epidemiology Workflow?

• October 2023 Community of Practice Bonus Call with Roche and GT Molecular
  

 Lab Matters Articles 

• SARS-CoV-2 Wastewater Monitoring: A Tool to Support COVID-19 Public Health Decision Making, Winter, 2021
  

• CDC and NCBI Coordinate Wastewater-based Genomic Surveillance Data, Summer 2021
  

• Wastewater Surveillance for More Than SARS-CoV-2, Summer, 2022
  

• Environmental Health Laboratory Fellows Make a Difference, Winter, 2022 

• Supporting Polio and Mpox Population Surveillance through Wastewater Testing, Spring, 2023
  

• Health Equity Through PFAS and Wastewater Surveillance, Summer, 2023
  

• Considerations for Implementing Wastewater Surveillance in Rural Communities, Winter, 2023
  

• NWSS Centers of Excellence Live Up to Their Name, Fall, 2024
  

APHL Blog Posts

Wastewater surveillance gained prominence during the pandemic. Where is it now? May, 2023

Relevant Monthly and Quarterly Calls

If you are interested in joining any of these calls, please email erin.morin@aphl.org.

• 2nd Monday, 1-2 pm ET: NWSS Laboratories Community of Practice, hosted by APHL 

• 3rd Thursday, 3-4 pm ET: NWSS Utilities Community of Practice, hosted by WEF  

• 4th Monday, 3-4 pm ET: APHL's WWS Technical User Group 

• 4th Thursday, 1-2 pm ET: NWSS Health Department Community of Practice, hosted by CDC 

• 1st Tuesday of the quarter (Jan, Apr, Jul, Oct), 3-4 pm ET: Oxford Nanopore Technical User Group

• 2nd Thursday of the quarter (Jan, Apr, Jul, Oct) 1-2 pm ET: GT Molecular Technical User Group

General Resources

• CDC National Wastewater Surveillance System COVID-19 Wastewater Data Visualizations 

• National and Regional Trends

• State and Territory Trends

• Current Wastewater Viral Activity Levels 

• Variants in Wastewater

• About Wastewater Da ta (Including Methods)

• NWSS Public SARS-CoV-2 Wastewater Metric Data Dashboard

• COVIDPoops19 Dashboard

• EPA Procedures for Collecting Wastewater Samples
  

• Water Environment Federation

• Water Resource Foundation

• KWR (Water research institute in the Netherlands)

• Research Consortium Network (RCN) Webinar Series: Wastewater-Based Epidemiology for Infectious Disease Targets  

• National Academies' Wastewater-Based Disease Surveillance for Public Health Action report

• American Council of Independent Laboratories' Draft Wastewater/SARS-CoV-2 Checklist  

• Water Environment Federation Network of Wastewater-Based Epidemiology

• National Association of County and City Health Officials' Wastewater Surveillance Resource Library: This toolkit contains background information on wastewater surveillance, guidance documents, communications materials, examples of dashboards, and more.

• Sewer Sleuths: Using Wastewater to Monitor Mpox: This webpage outlines how CDC is using and has used wastewater surveillance in multiple mpox outbreaks

• The National Wastewater Surveillance System (NWSS): From inception to widespread coverage, 2020–2022, United States: highlights the evolution of NWSS from its inception in 2020 through 2022.

• Public Health Agency of Canada Wastewater Dashboard: This dashboard provides data about respiratory virus levels, including SARS-CoV-2 (COVID-19), influenza (flu) and respiratory syncytial virus (RSV) in wastewater (sewage) in Canada.

• Wastewater-Based Surveillance for Public Health: Knowledge-to-Action Series: Developed by the Canadian Water Network (CWN) developed this series to support over 30 public health