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Wastewater Surveillance of Pathogens Can Inform Public Health Responses

Wastewater monitoring has been used to identify SARS-CoV-2 outbreaks and track new variants. This sentinel system should be expanded to monitor other pathogens and boost public health preparedness.

Since the late 1930s, scientists have known that infectious poliovirus was present in the sewage of cities experiencing outbreaks1. As a result, wastewater surveillance has played an important part in the polio-eradication campaign2. Building from the work on poliovirus, data from wastewater have complemented clinical surveillance during the Covid-19 pandemic by offering a comprehensive view of infection burden and transmission — both symptomatic and asymptomatic — and information on which SARS-CoV-2 variants are circulating in a community3,4 (including so-called cryptic variants that have never been detected in clinical samples5). Yet despite the established value of wastewater surveillance for monitoring poliovirus and its emerging importance during the Covid-19 pandemic, most global public health surveillance systems still rely heavily on medically attended case data6. This needs to change to enable effective pandemic preparedness and response.

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This article first appeared in Nature Medicine on September 8th.