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The science of sewage

Can we get a better idea of disease behavior by looking at wastewater?

When it comes to gaining a deeper understanding of infectious diseases and the spread of illnesses, sometimes the best thing to do is to look to our sewage. Enter wastewater monitoring, a technique that examines biological or chemical indicators in sewage to provide more information on the health of a community. Wastewater surveillance has been around since the 1850s, when the industrialized and extremely populous city of London was dealing with influenza, typhoid and cholera outbreaks. A local doctor mapped cholera cases around the city and discovered that contaminated water was the source of the epidemics. This led to more support for the sanitation movement, laid the foundation for recognizing waterborne pathogens and diseases and was key in the eventual development of wastewater surveillance strategies.

Fast-forward to the US in the 1930s. Well into the second decade of a polio epidemic, two Yale doctors suggested that examining sewage could be useful in tracking outbreaks. It was: They identified poliovirus in several wastewater samples and noted that the virus could not be detected during non-epidemic periods, demonstrating that viral peaks in wastewater could show peaks in community infection. 

At the peak of the COVID-19 pandemic, there was often a lack of publicly available testing: PCR tests were hard to come by and rapid antigen tests weren’t totally reliable. One of the key tools deployed for tracking changes in coronavirus activity was wastewater monitoring, used as an early indicator of the presence of infections not detected by clinical testing. Wastewater monitoring for SARS-CoV-2 offered scientists and officials a public health snapshot in the absence of symptoms and individual testing, and was especially useful in determining the Omicron variant’s spread throughout communities. 

Before the COVID-19 pandemic, researchers weren’t sure that respiratory viruses could be tracked using wastewater surveillance. Now, the public health possibilities of this tool are myriad: Wastewater monitoring can be used to track the global movement of pathogens, assess cross-contamination of bodies of water following floods or hurricanes or determine levels of and combat antimicrobial resistance. Wastewater-based epidemiology could even be used in the future to provide early warnings of other pandemics.  

Successful wastewater monitoring requires utilizing effective and efficient tools and technologies. Automated microfluidics-based qPCR on the Biomark™ X9 System for High-Throughput Genomics allows for multiple pathogens to be simultaneously identified and genomically profiled to effectively monitor and manage outbreaks. This can lead to more efficient disease diagnosis, empower the generation of timely answers and overall better equip public health surveillance systems to meet the rapidly changing needs of pathogen and disease monitoring.



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