Abstract

Background:

Wastewater testing offers a cost-effective strategy for measuring population disease prevalence and health behaviors. For COVID-19, wastewater surveillance addresses testing gaps and provides an early warning for outbreaks. As U.S. federal agencies build a National Wastewater Surveillance System around the pandemic, thinking through ways to develop flexible frameworks for wastewater sampling, testing, and reporting can avoid unnecessary system overhauls for future infectious disease, chronic disease, and drug epidemics.

Objectives:

We discuss ways to transform a historically academic exercise into a tool for epidemic response. We generalize lessons learned by a global network of wastewater researchers around validation and implementation for COVID-19 and opioids while also drawing on our experience with wastewater-based epidemiology in the United States.

Discussion:

Sustainable wastewater surveillance requires coordination between health and safety officials, utilities, labs, and researchers. Adapting sampling frequency, type, and location to threat level, community vulnerability, biomarker properties, and decisions that wastewater data will inform can increase the practical value of the data. Marketplace instabilities, coupled with a fragmented testing landscape due to specialization, may require officials to engage multiple labs to test for known and unknown threats. Government funding can stabilize the market, balancing commercial pressures with public good, and incentivize data sharing. When reporting results, standardizing metrics and contextualizing wastewater data with health resource data can provide insights into a community’s vulnerability and identify strategies to prevent health care systems from being overwhelmed. If wastewater data will inform policy decisions for an entire community, comparing characteristics of the wastewater treatment plant’s service population to those of the larger community can help determine whether the wastewater data are generalizable. Ethical protocols may be needed to protect privacy and avoid stigmatization. With data-driven approaches to sample collection, analysis, and interpretation, officials can use wastewater surveillance for adaptive resource allocation, pandemic management, and program evaluation. https://doi.org/10.1289/EHP8572

中文翻译：

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开发适用于COVID-19及更高版本的灵活的全国废水监控系统

摘要

背景：

废水测试提供了一种经济有效的策略来测量人群疾病的患病率和健康行为。对于COVID-19，废水监测解决了测试方面的空白，并为疫情暴发提供了预警。随着美国联邦机构围绕大流行病建立国家废水监测系统，通过思考为废水采样，测试和报告开发灵活的框架的方法，可以避免对未来的传染病，慢性病和药物流行进行不必要的系统检修。

目标：

我们讨论了将历史上的学术活动转变为流行病应对工具的方法。我们总结了全球废水研究人员网络关于COVID-19和阿片类药物的验证和实施的经验教训，同时还借鉴了我们在美国基于废水的流行病学方面的经验。

讨论：

可持续废水监测需要卫生与安全官员，公用事业，实验室和研究人员之间的协调。使采样频率，类型和位置适应威胁级别，社区脆弱性，生物标志物属性以及废水数据将要做出的决策，可以提高数据的实用价值。市场的不稳定性，再加上由于专业化而导致的测试环境分散，可能需要官员参与多个实验室来测试已知和未知的威胁。政府资金可以稳定市场，平衡商业压力与公共利益，并激励数据共享。报告结果时，将指标数据标准化和将废水数据与卫生资源数据进行上下文关联可以提供对社区脆弱性的见解，并确定防止卫生保健系统不堪重负的策略。如果废水数据可以为整个社区的决策提供依据，则将废水处理厂服务人口的特征与较大社区的服务特征进行比较，可以帮助确定废水数据是否可以推广。可能需要道德协议来保护隐私并避免污名化。借助数据驱动的样本收集，分析和解释方法，官员可以将废水监测用于适应性资源分配，大流行管理和计划评估。https://doi.org/10.1289/EHP8572 如果废水数据可以为整个社区的决策提供依据，则将废水处理厂服务人口的特征与较大社区的服务特征进行比较，可以帮助确定废水数据是否可以推广。可能需要道德协议来保护隐私并避免污名化。借助数据驱动的样本收集，分析和解释方法，官员可以将废水监测用于适应性资源分配，大流行管理和计划评估。https://doi.org/10.1289/EHP8572 如果废水数据可以为整个社区的决策提供依据，则将废水处理厂服务人口的特征与较大社区的服务特征进行比较，可以帮助确定废水数据是否可以推广。可能需要道德协议来保护隐私并避免污名化。借助数据驱动的样本收集，分析和解释方法，官员可以将废水监测用于适应性资源分配，大流行管理和计划评估。https://doi.org/10.1289/EHP8572 借助数据驱动的样本收集，分析和解释方法，官员可以将废水监测用于适应性资源分配，大流行管理和计划评估。https://doi.org/10.1289/EHP8572 借助数据驱动的样本收集，分析和解释方法，官员可以将废水监测用于适应性资源分配，大流行管理和计划评估。https://doi.org/10.1289/EHP8572