Waterborne diseases are a major global problem, resulting in high morbidity and mortality, and massive economic costs. The ability to rapidly and reliably detect and monitor the spread of waterborne diseases is vital for early intervention and preventing more widespread disease outbreaks. Pathogens are, however, difficult to detect in water and are not practicably detectable at acceptable concentrations that need to be achieved in treated drinking water (which are of the order one per million litre). Furthermore, current clinical-based surveillance methods have many limitations such as the invasive nature of the testing and the challenges in testing large numbers of people. Wastewater-based epidemiology (WBE), which is based on the analysis of wastewater to monitor the emergence and spread of infectious disease at a population level, has received renewed attention in light of the current coronavirus disease 2019 (COVID-19) pandemic. The present review will focus on the application of WBE for the detection and surveillance of pathogens with a focus on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the waterborne protozoan parasites Cryptosporidium and Giardia. The review highlights the benefits and challenges of WBE and the future of this tool for community-wide infectious disease surveillance.

水传播疾病是一个重大的全球性问题，导致高发病率和死亡率以及巨大的经济成本。快速、可靠地检测和监测水传播疾病传播的能力对于早期干预和防止更广泛的疾病爆发至关重要。然而，病原体很难在水中检测到，并且在经过处理的饮用水（约为每百万升）中需要达到的可接受浓度下实际上无法检测到。此外，当前基于临床的监测方法有许多局限性，例如测试的侵入性以及对大量人群进行测试的挑战。基于废水的流行病学 (WBE) 基于废水分析，以监测人口层面传染病的出现和传播，鉴于当前 2019 年冠状病毒病 (COVID-19) 大流行，该方法再次受到关注。本综述将重点关注 WBE 在病原体检测和监测中的应用，重点关注严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 和水生原生动物寄生虫隐孢子虫和贾第鞭毛虫。该审查强调了 WBE 的好处和挑战以及该工具在社区范围内传染病监测方面的未来。