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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为 COVID-19 及以后开发灵活的国家废水监测系统。

背景技术废水检测为测量人群疾病流行率和健康行为提供了一种经济有效的策略。对于 COVID-19，废水监测解决了检测差距，并为爆发提供了早期预警。随着美国联邦机构围绕大流行建立国家废水监测系统，思考如何为废水采样、测试和报告制定灵活的框架可以避免对未来传染病、慢性病和药物流行病进行不必要的系统检修。目标 我们讨论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围绕 COVID-19 和阿片类药物的验证和实施所吸取的经验教训，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 可持续的废水监测需要健康和安全官员、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告知的决策可以增加数据的实用价值。市场不稳定，加上专业化导致的分散测试环境，可能需要官员与多个实验室合作，以测试已知和未知的威胁。政府资金可以稳定市场，平衡商业压力和公共利益，并激励数据共享。在报告结果时，标准化指标并将废水数据与卫生资源数据关联起来，可以深入了解社区的脆弱性，并确定防止卫生保健系统不堪重负的策略。如果废水数据将为整个社区的政策决策提供信息，那么将废水处理厂服务人口的特征与更大社区的特征进行比较有助于确定废水数据是否具有普遍性。可能需要道德协议来保护隐私和避免污名化。通过数据驱动的样本收集、分析和解释方法，官员可以使用废水监测进行适应性资源分配、流行病管理和项目评估。https://doi.org/10.1289/EHP8572。