Examples of Public Health Uses of Wastewater Data
Last updated April 4, 2024
There are dozens of wastewater surveillance programs across the United States, designed to address gaps in traditional public health surveillance efforts. While state health departments often manage these programs, the translation of wastewater data into direct public health actions typically occurs at the local health department or institutional level. The examples below showcase the diverse applications of wastewater data by health departments. It is crucial to keep in mind that the wastewater data, while valuable, require additional contextual information for actionable insights. Notably, all the examples provided involve tracking SARS-CoV-2, which initially prompted the inception of these programs. However, these initiatives are rapidly evolving to encompass a broader spectrum of pathogens and other targets.
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City of Tempe, Arizona
Through their Wastewater BioIntel Program, the City of Tempe monitors eleven sewersheds representing 100% of the City’s sewered population using 24-hour composite samples collected two to seven times per week from manholes. Samples are analyzed for SARS-CoV-2, respiratory viruses (influenza A and B, influenza A H1N1, and respiratory syncytial virus A and B), gastrointestinal viruses (hepatitis A and norovirus GI and GII), vector-borne viruses (West Nile virus), other viruses (adenovirus 41, pan-adenovirus, and enterovirus D68), and opioids (fentanyl, norfentanyl, heroin, 6-acetylmorphine, oxycodone, noroxycodone, and codeine) by four partners laboratories (Arizona State University Biodesign Institute, Arizona State Public Health Laboratory, Translational Genomics Research Institute North, and Murray State University). To advance public health and serve as a national model, the City of Tempe utilizes wastewater data to inform strategic policy and operational decisions about local, community health. Examples include education about emerging infectious diseases or outreach about unhealthy behavior or conditions. The data also informs collaborations with other health agencies and service providers about prevention programs and treatment services. The wastewater data are also available to the public on a series of dashboards.
Las Vegas, Nevada
As part of the Nevada EMPOWER Program, the University of Nevada, Las Vegas (UNLV) and the Southern Nevada Water Authority (SNWA) monitor wastewater in multiple locations in Las Vegas. Composite wastewater samples are collected once or twice per week from local water resource recovery facilities and from manholes serving UNLV dorms, Harry Reid International Airport, the Las Vegas Strip, and other areas. At the Oh Laboratory at UNLV, samples are analyzed by qPCR and whole genome sequencing for SARS-CoV-2, mpox, antimicrobial resistance, and other public health markers. Local and state public health officials utilize the wastewater data to aid in selecting and implementing appropriate public health interventions, ultimately allowing for more efficient use of public health resources. One example was the detection of mpox in the wastewater collection system, which prompted strategic vaccine deployment and informational campaigns led by the Southern Nevada Health District (SNHD). Another example was the frequent detection of the antifungal-resistant yeast Candida auris in certain areas of Southern Nevada, prompting expanded point prevalence surveys in relevant healthcare facilities. The Nevada EMPOWER Program is a collaboration between SNHD, UNLV, SNWA, and the Desert Research Institute and includes SARS-CoV-2 data sharing on a public dashboard with current viral counts and variants.
A list of publications from this collaboration can be found here.
North Dakota Correctional Facilities
The North Dakota Department of Health and Human Services (DHHS) monitors two North Dakota correctional facilities using 24-hour composite wastewater samples collected from each facility five days per week. Samples are analyzed for SARS-CoV-2, influenza A and B, and respiratory syncytial virus by DHHS. DHHS shares the wastewater concentrations (unnormalized gene copies per L) with the correctional facility management, who use the information to make operational decisions within the facility. These decisions may include things like frequency of testing residents and staff as well as offering masking and highly encouraging their use, especially when the SARS-CoV-2 concentrations are higher.
Santa Clara County, California
The Wastewater Based Epidemiology Program run by the County of Santa Clara Public Health Department relies on 24-hour composite raw influent samples collected seven days per week from all four water resource recovery facilities in the county, representing 98% of the county’s population. In collaboration with Stanford University, samples are analyzed for respiratory viruses (SARS-CoV-2, influenza A and B, and respiratory syncytial virus [RSV]), and results are normalized by pepper mild mottle virus. Their Stanford partners via WastewaterSCAN are tracking other respiratory viruses (human metapneumovirus, enterovirus D68, and parainfluenza), gastrointestinal viruses (norovirus, rotavirus, and human adenovirus Group F), and other pathogens (mpox virus and Candida auris). SARS-CoV-2 concentrations in wastewater are a critical source of COVID information for the Public Health Department. The Department shares the respiratory virus wastewater data in press releases, press conferences, Board of Supervisors meetings, and healthcare provider meetings, and uses them to inform recommendations for masking and other non-pharmaceutical interventions. In addition, area hospitals use the wastewater data for preparedness and surge planning. The mpox wastewater data provide Public Health with a critical, timely complement to clinical testing and, therefore, a more accurate picture of community disease transmission. The Public Health Department maintains a dashboard for SARS-CoV-2 wastewater data, as well as a dashboard for flu and RSV wastewater data. Data for additional wastewater analytes are displayed on the WastewaterSCAN dashboard. Information about COVID wastewater surveillance in other California communities is provided on the California Department of Public Health’s Cal-SuWers page.
