In the face of emerging and re-emerging diseases, novel and innovative approaches to population scale surveillance are necessary for the early detection and quantification of pathogens. The last decade has seen the rapid development of wastewater and environmental surveillance (WES) to address public health challenges, which has led to establishment of wastewater-based epidemiology (WBE) approaches being deployed to monitor a range of health hazards. WBE exploits the fact that excretions and secretions from urine, and from the gut are discharged in wastewater, particularly sewage, such that sampling sewage systems provides an early warning system for disease outbreaks by providing an early indication of pathogen circulation. While WBE has been mainly used in locations with networked wastewater systems, here we consider its value for less connected populations typical of lower-income settings, and in assess the opportunity afforded by pit latrines to sample communities and localities. We propose that where populations struggle to access health and diagnostic facilities, and despite several additional challenges, sampling unconnected wastewater systems remains an important means to monitor the health of large populations in a relatively cost-effective manner.

中文翻译：

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基于废水的流行病学作为中低收入环境中的公共卫生资源


面对新出现和重新出现的疾病，需要采用新颖和创新的人口规模监测方法来早期检测和量化病原体。过去十年，为了应对公共卫生挑战，废水和环境监测 (WES) 得到了快速发展，从而建立了基于废水的流行病学 (WBE) 方法，用于监测一系列健康危害。 WBE 利用尿液和肠道的排泄物和分泌物被排放到废水（特别是污水）中的事实，使得污水采样系统通过提供病原体循环的早期指示，为疾病爆发提供早期预警系统。虽然 WBE 主要用于拥有联网废水系统的地区，但在这里，我们考虑了其对于低收入环境中典型的联系较少的人群的价值，并评估坑式厕所为社区和地区抽样提供的机会。我们建议，在人们难以获得医疗和诊断设施的地方，尽管存在一些额外的挑战，但对未连接的废水系统进行采样仍然是以相对具有成本效益的方式监测大量人口健康状况的重要手段。