Introduction to Wastewater Disease Surveillance

The Centers for Disease Control and Prevention (CDC) has published two studies highlighting the effectiveness of wastewater testing in tracking diseases such as measles. Wastewater testing can alert public health officials to measles infections days to months before cases are confirmed by doctors. Colorado health officials were able to get ahead of the highly contagious virus by tracking its presence in sewer systems, researchers wrote. And Oregon researchers found wastewater could have warned them of an outbreak more than two months before the first person tested positive.

Importance of Wastewater Testing

The findings add to evidence that wastewater testing is a valuable weapon in tracking disease, including COVID-19, polio, mpox, and bird flu.
Peggy Honein, director of the CDC’s division of infectious disease readiness and innovation, said the proposed funding level would “sustain some of the most critical activities” but “it would likely require some prioritization.” The national system covers more than 1,300 wastewater treatment sites serving 147 million people. It includes six “centers for excellence” — Colorado among them — that innovate and support other states in expanding their testing.

States Prepare for Potential Funding Cuts

The funding cut is still a proposal, and Congress has started pushing back against cuts to health care in general. But state health departments say they are preparing for a potential loss of federal support regardless. Most state programs are entirely federally funded, Honein said. Colorado started its wastewater surveillance program in 2020 with 68 utilities participating voluntarily. The program has since narrowed in its focus even as it grew to include more diseases, because it is 100% federally funded, said Allison Wheeler, manager of the Colorado’s wastewater surveillance unit.

Measles Detection Through Wastewater

In the Colorado study, which Wheeler co-authored, officials started testing wastewater for measles in May, as outbreaks in Texas, New Mexico, and Utah were growing and five cases had been confirmed in Colorado. In August, wastewater in Mesa County tested positive about a week before two measles cases were confirmed by a doctor. Neither patient knew that they had been exposed to measles. As they traced 225 household and health care contacts of the first two patients, health officials found five more cases. In Oregon, researchers used preserved sewage samples from late 2024 to determine if sewage testing could have discovered a burgeoning outbreak.

State-Level Initiatives and Success Stories

Other states, such as Utah, have integrated wastewater data into their public-facing measles dashboards, allowing anyone to track outbreaks in real time. And in New Mexico, where 100 people got measles last year and one died, the testing helped state health officials shrink a vast rural expanse. The state’s system flagged cases in northwestern Sandoval County while officials were focused on a massive outbreak 300 miles (483 kilometers) away in the southeast, said Kelley Plymesser, of the state health department. The early warning allowed the department to alert doctors and the public, lower thresholds for testing, and refocus their resources.

Conclusion

The value of wastewater surveillance in detecting and managing disease outbreaks is clear. As demonstrated by the studies in Colorado and Oregon, this method can provide early warnings of measles outbreaks, allowing for timely interventions. The potential funding cut to the national wastewater surveillance system poses a significant risk to these efforts, and it is crucial for federal leaders to recognize the importance and effectiveness of this surveillance method. Continued support for wastewater surveillance is essential for protecting public health, especially in the face of ongoing and emerging disease threats.

FAQs

• Q: What is wastewater surveillance, and how does it help in disease tracking?
  A: Wastewater surveillance involves testing sewage for the presence of pathogens, such as viruses and bacteria, to detect disease outbreaks early. This method can alert health officials to potential outbreaks before cases are confirmed by doctors, allowing for quicker intervention.
• Q: How effective is wastewater testing in detecting measles outbreaks?
  A: According to CDC studies, wastewater testing can detect measles infections days to months before cases are confirmed clinically. This early detection is crucial for managing outbreaks effectively.
• Q: What is the current funding situation for the national wastewater surveillance system, and what are the implications of potential cuts?
  A: The proposed budget plan would significantly reduce funding for the national wastewater surveillance system. This reduction could force prioritization of activities, potentially impacting the system’s effectiveness in tracking diseases across the country.
• Q: How do states benefit from wastewater surveillance, and what initiatives have they implemented?
  A: States benefit from early warnings of disease outbreaks, which enable targeted interventions. Some states, like Utah, have integrated wastewater data into public dashboards, enhancing transparency and public awareness of outbreaks.