Increasing the Utility of Wastewater-based Disease Surveillance for Public Health Action: A Phase 2 Report (2024)
Chapter: Front Matter
Consensus Study Report
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International Standard Book Number-13: 978-0-309-71620-8
International Standard Book Number-10: 0-309-71620-9
Digital Object Identifier: https://doi.org/10.17226/27516
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Increasing the Utility of Wastewater-based Disease Surveillance for Public Health Action: A Phase 2 Report. Washington, DC: The National Academies Press. https://doi.org/10.17226/27516.
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COMMITTEE ON COMMUNITY WASTEWATER-BASED INFECTIOUS DISEASE SURVEILLANCE
GUY H. PALMER (NAM), Chair, Washington State University, Spokane, WA
AMI S. BHATT, Stanford University, Palo Alto, CA
MARISA C. EISENBERG, University of Michigan, Ann Arbor, MI
RAUL A. GONZALEZ, H2O Molecular, San Diego, CA
CHARLES N. HAAS (NAE), Drexel University, Philadelphia, PA
LOREN P. HOPKINS, Houston Health Department and Rice University, Houston, TX
NA’TAKI OSBORNE JELKS, Spelman College, Atlanta, GA
CHRISTINE K. JOHNSON (NAM), University of California, Davis, CA
ROB KNIGHT (NAE), University of California, San Diego, CA
SANDRA L. MCLELLAN, University of Wisconsin–Milwaukee, WI
MICHELLE M. MELLO (NAM), Stanford University, Palo Alto, CA
JOHN SCOTT MESCHKE, University of Washington, Seattle, WA
REKHA SINGH, Virginia Department of Health, Charlottesville, VA
KRISTA WIGGINTON, University of Michigan, Ann Arbor, MI
Study Staff
STEPHANIE E. JOHNSON, Study Director, Water Science and Technology Board
JUSTIN CHATMAN, Program Assistant, Water Science and Technology Board (until January 2024)
SAMUEL KRAFT, Senior Program Assistant, Water Science and Technology Board
MILES LANSING, Senior Program Assistant, Water Science and Technology Board
WATER SCIENCE AND TECHNOLOGY BOARD
DAVID L. SEDLAK (NAE), Chair, University of California, Berkeley, CA
NEWSHA K. AJAMI, Lawrence Berkeley National Laboratory, Berkeley, CA
PEDRO J. ALVAREZ, Rice University, Houston, TX
MARTIN DOYLE, Duke University, Durham, NC
JORDAN R. FISCHBACH, The Water Institute of the Gulf, Pittsburgh, PA
SHEMIN GE, University of Colorado, Boulder
ELLEN GILINSKY, Ellen Gilinsky, LLC., Richmond, VA
ROBERT M. HIRSCH, U.S. Geological Survey, Reston, VA
BRANKO KERKEZ, University of Michigan, Ann Arbor, MI
YUSUKE KUWAYAMA, University of Maryland, Baltimore County
VENKATARAMAN LAKSHMI, University of Virginia, VA
CAMILLE PANNU, Columbia University, New York, NY
AMY PRUDEN, Virginia Tech, Blacksburg, VA
JENNIFER TANK, University of Notre Dame, Notre Dame, IN
CRYSTAL L. TULLEY CORDOVA, Navajo Nation Department of Water Resources, Yahtahey, NM
Staff
DEBORAH GLICKSON, Board Director
LAURA EHLERS, Senior Program Officer
STEPHANIE JOHNSON, Senior Program Officer
MARGO REGIER, Program Officer
CHARLES BURGIS, Associate Program Officer
JONATHAN TUCKER, Associate Program Officer
NOEL WALTERS, Associate Program Officer
JEANNE AQUILINO, Finance Business Partner
EMILY BERMUDEZ, Senior Program Assistant
MAYA FREY, Senior Program Assistant
SAMUEL KRAFT, Senior Program Assistant
MILES LANSING, Senior Program Assistant
BOARD ON POPULATION HEALTH AND PUBLIC HEALTH PRACTICE
BRUCE N. CALONGE, Chair, Colorado School of Public Health, Aurora, CO
MARCELLA ALSAN, Harvard University, Cambridge, MA
ANA V. DIEZ ROUX, Drexel University, Philadelphia, PA
LAURA HERRERA SCOTT, Maryland Department of Health, Baltimore
DORA HUGHES, Centers for Medicare and Medicaid Services, Washington, DC
TAMARRA JAMES-TODD, Harvard University, Cambridge, MA
NICOLA KLEIN, Kaiser Permanente Northern California, Oakland
MARGARET MOSS, University of Minnesota School of Nursing, Minneapolis
JEWEL MULLEN, University of Texas at Austin
ANAND PAREKH, Bipartisan Policy Center, Washington, DC
THERESE S. RICHMOND, University of Pennsylvania, Philadelphia
JOSHUA SALOMON, Stanford University, Stanford, CA
MELISSA A. SIMON, Northwestern University, Evanston, IL
SYLVIA TRENT-ADAMS, University of North Texas, Denton
SEAN D. YOUNG, University of California, Irvine
Staff
ROSE MARIE MARTINEZ, Senior Board Director
KATHLEEN STRATTON, Scholar
ALINA BACIU, Senior Program Officer
ELIZABETH BARKSDALE BOYLE, Senior Program Officer
DONNA ALMARIO DOEBLER, Senior Program Officer
AMY GELLER, Senior Program Officer
LESLIE Y. KWAN, Senior Program Officer
ANNE STYKA, Senior Program Officer
ALEXANDRA ANDRADA, Program Officer
AISHA BHIMLA, Program Officer
OGAN KUMOVA, Program Officer
AIMEE MEAD, Program Officer
RONIQUE TAFFE, Program Officer
ALEXIS WOJTOWICZ, Program Officer
ZARAH BATULAN, Associate Program Officer
NEHA DIXIT, Associate Program Officer
KHALA HURST-BEATTY, Associate Program Officer
DARA ANCONA, Associate Program Officer
NICHOLAS MURDOCK, Associate Program Officer
AASHAKA SHINDE, Associate Program Officer
L. BRIELLE DOJER, Research Associate
EMMA FLETCHER, Research Associate
ALEXANDRA MCKAY, Research Associate
STEPHANIE PUWALSKI, Research Associate
Y. CRYSTI PARK, Program Coordinator
MAGGIE ANDERSON, Research Assistant
GRACE READING, Senior Program Assistant
MIA SALTRELLI, Senior Program Assistant
Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Although these reviewers provided many constructive comments and suggestions, they were not asked to endorse the conclusions and recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by RHODES TRUSSELL (NAE), Trussell Technologies Inc., and GEORGES C. BENJAMIN (NAM), American Public Health Association. Appointed by the National Academies, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments received full consideration. Responsibility for the final content of this report rests entirely with the authoring committee and the National Academies.
Acronyms
| APHL | Association of Public Health Laboratories |
| BSL | biosafety level |
| CDC | U.S. Centers for Disease Control and Prevention |
| DCIPHER | Data Collation and Integration for Public Health Event Response |
| ddPCR | droplet digital polymerase chain reaction |
| DNA | deoxyribonucleic acid |
| dPCR | digital polymerase chain reaction |
| ED | emergency department |
| EMMI | Environmental Microbiology Minimum Information |
| EPA | U.S. Environmental Protection Agency |
| ESBL | extended spectrum β-lactamase |
| ESSENCE | Electronic Surveillance System for the Early Notification of Community-Based Epidemics |
| EVD68 | enterovirus D68 |
| EWMA | exponentially weighted moving average |
| HHS | U.S. Department of Health and Human Services |
| HMPV | human metapneumovirus |
| HPIV | human parainfluenza |
| HUS | hemolytic uremic syndrome |
| ICU | intensive care unit |
| IIS | Immunization Information System |
| LODES | Longitudinal Employer-Household Dynamics Origin-Destination Employment Statistics |
| LOQ | limit of quantitation |
| LOWESS | locally weighted scatterplot smoothing |
| MERS-CoV | Middle East respiratory syndrome coronavirus |
| MIQE | Minimum Information for Publication of Quantitative Real-Time PCR Experiments |
| MPN | most probable number |
| MSA | metropolitan statistical area |
| NEDSS | National Electronic Disease Surveillance System |
| NIH | National Institutes of Health |
| NNDSS | National Notifiable Diseases Surveillance System |
| NSF | National Science Foundation |
| NSSIL | National Sewage Surveillance Interagency Leadership |
| NSSP | National Syndromic Surveillance Program |
| NWSS | National Wastewater Surveillance System |
| PCR | polymerase chain reaction |
| PMMoV | pepper mild mottle virus |
| QA-QC | quality assurance and quality control |
| qPCR | quantitative polymerase chain reaction |
| RNA | ribonucleic acid |
| rRNA | ribosomal ribonucleic acid |
| RSV | respiratory syncytial virus |
| RT-PCR | reverse transcription polymerase chain reaction |
| RT-qPCR | reverse transcription-quantitative polymerase chain reaction |
| SEIR | Susceptible–Exposed–Infected–Recovered |
| SOP | standard operating procedure |
| STEC | Shiga-toxin-producing E. coli |
| STI | sexually transmitted infection |
| SVI | Social Vulnerability Index |
| TSE | transmissible spongiform encephalopathy |
| TSS | total suspended solids |
| USDA | U.S. Department of Agriculture |
| USGS | U.S. Geological Survey |
| WastewaterSCAN | Sewer Coronavirus Alert Network |
| WEF | Water Environment Federation |
| WHO | World Health Organization |
| WVAL | wastewater viral activity level |
| WWTP | wastewater treatment plant |
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Contents
Wastewater Surveillance in the United States
2 SAMPLING METHODS FOR ENDEMIC PATHOGENS
Conclusions and Recommendations
3 ANALYTICAL METHODS AND QUALITY CONTROL FOR ENDEMIC PATHOGENS
Opportunities to Improve Data Utility
Conclusions and Recommendations
4 DATA ANALYSIS, INTEGRATION, AND INTERPRETATION FOR ENDEMIC PATHOGENS
Visualization and Data Analysis Tools for Integration and Interpretation
Advancing Statistical Tools for Interpretation and Prediction
Public Health Response Guidance
Evaluating the Public Health Value of the Wastewater Surveillance System
Conclusions and Recommendations
5 POTENTIAL TARGET EXPANSION FOR NATIONAL ENDEMIC DISEASE SURVEILLANCE
Current and Potential Respiratory Virus Targets
Potential Enteric Pathogen Targets
Antibiotic Resistance Gene Targets
Other Potential Endemic Targets
Considerations When Refining NWSS Endemic Targets
Conclusions and Recommendations
6 WASTEWATER SURVEILLANCE FOR EMERGING PATHOGEN THREATS
Vision for Wastewater Surveillance for Known, Emerging Pathogen Threats
Sampling for Emerging Pathogen Threats
Analytical Methods for Known, Emerging Pathogens
Data Analysis, Interpretation, Communication, and Intervention Planning for Emerging Pathogens
Emerging Techniques for Future Public Health Monitoring of Unrecognized Pathogens
