Wastewater surveillance has been used for decades outside the US 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. In response to the pandemic, the US Centers for Disease Control and Prevention (CDC) developed the National Wastewater Surveillance System (NWSS) to facilitate the use of nationwide public health infrastructure to test wastewater for targets of public health concern.
Health departments and laboratories continue to expand their capabilities to test for other targets of public health concern, such as influenza (including H5N1 bird flu), respiratory syncytial virus, mpox, anti-microbial resistant genes, polio, measles, chemical targets 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 sewer lines where a wastewater sample is collected prior to utility treatment. The sample is taken to a laboratory to extract, concentrate and quantitate the target's DNA, RNA, or other genetic substance. Laboratory results can provide community insight as to whether a target of interest is present, increasing or decreasing in concentration or genetically changing.
Wastewater surveillance data 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.
Community of Practice Calls
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 meet these qualifications and are interested in joining, please create an APHL account and email [email protected].
Participants can attend two different calls through the community of practice:
Peer-to-Peer Exchange Program
APHL’s wastewater surveillance peer-to-peer training program sponsors public health laboratories that submit data to NWSS to visit peer laboratories, and if of interest, epidemiology or other partners. During these visits, participants build awareness of how other jurisdictions run their wastewater surveillance program, learn about topics of need and interest, and expand the network of laboratories, epidemiologists and other partners that can connect with each other in the future to further enhance their wastewater surveillance programs. Applications for the 2025-2026 cohort have closed.
Wastewater Surveillance Survey
APHL conducts a bi-annual national survey to characterize laboratory capability and capacity. The results provide a metric for laboratories to understand how their approaches compare to other laboratories. They 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.
Please explore the 2025 Wastewater Surveillance Survey results through the dashboard below. Between June 30 -September 30, 2025, APHL invited 104 state, local and territorial public health, university, utility and private laboratories to participate in the survey. If laboratories contracted out testing, a survey was also sent to that laboratory. This added six laboratories, bringing the total to 110 invited laboratories with an overall response rate of 95% (105/110). The five 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.
Coming soon! National Trends in Wastewater Surveillance: 2025 Survey Report
