Worldwide, clinical data remain the gold standard for disease surveillance and tracking. However, such data are limited due to factors such as reporting bias and inability to track asymptomatic disease carriers. Disease agents are excreted in the urine and feces of infected individuals regardless of disease symptom severity. Wastewater surveillance – that is, monitoring disease via human effluent – represents a valuable complement to clinical approaches. Because wastewater is relatively inexpensive and easy to collect and can be monitored at different levels of population aggregation as needed, wastewater surveillance can offer a real-time, cost-effective view of a community's health that is independent of biases associated with case-reporting. For SARS-CoV-2 and other disease-causing agents we envision an aggregate wastewater-monitoring system at the level of a wastewater treatment plant and exploratory or confirmatory monitoring of the sewerage system at the neighborhood scale to identify or confirm clusters of infection or assess impact of control measures where transmission has been established. Implementation will require constructing a framework with collaborating government agencies, public or private utilities, and civil society organizations for appropriate use of data collected from wastewater, identification of an appropriate scale of sample collection and aggregation to balance privacy concerns and risk of stigmatization with public health preservation, and consideration of the social implications of wastewater surveillance.

在世界范围内，临床数据仍然是疾病监测和追踪的黄金标准。然而，由于报告偏倚和无法追踪无症状疾病携带者等因素，此类数据有限。无论疾病症状的严重程度如何，病原体都会从感染者的尿液和粪便中排出。废水监测——即通过人体排泄物监测疾病——是对临床方法的宝贵补充。由于废水相对便宜且易于收集，并且可以根据需要在不同的人口聚集水平上进行监测，因此废水监测可以提供一个实时的、具有成本效益的社区健康视图，而不受与病例报告相关的偏见的影响。对于 SARS-CoV-2 和其他致病因子，我们设想在废水处理厂层面建立一个综合废水监测系统，并在社区范围内对污水处理系统进行探索性或确认性监测，以识别或确认感染群或评估已确定传播的控制措施的影响。实施将需要与政府机构、公共或私营公用事业机构以及民间社会组织合作构建一个框架，以适当使用从废水中收集的数据，确定适当规模的样本收集和汇总，以平衡隐私问题和污名化风险与公共卫生保存，并考虑废水监测的社会影响。