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Defining a research agenda for environmental wastewater surveillance of pathogens

Nature Medicine volume 29, pages 2155–2157 (2023)Cite this article

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Environmental surveillance, defined as the systematic collection of samples and associated data on infectious-disease-related pathogens from wastewater for the purpose of informing decisions, has a rich tradition in public health. High-resource settings such as the USA1 and Europe2 have started to implement environmental surveillance networks for the use of multi-pathogen data from wastewater, including for pandemic preparedness. Implementing environmental surveillance in lower-resource settings, in which a large proportion of populations live in houses not connected to convergent sewer systems, has lagged due to epidemiological and resource challenges. Correcting this imbalance is important to ensure equitable access to actionable surveillance.

The Bill & Melinda Gates Foundation hosted a meeting in May 2022, bringing together academic, manufacturing and public-health decision-making partners to co-develop a vision for multi-pathogen environmental surveillance, which we report on here. Environmental surveillance could complement clinical surveillance by potentially supporting the detection of multiple pathogens by a single surveillance network at a fraction of the per-capita cost of case-based surveillance. During our discussions, we focused on seven pathogens that were proposed by the group: poliovirus, Salmonella enterica serovar Typhi, Vibrio cholerae, SARS-CoV-2, hepatitis A virus, hepatitis E virus and measles virus. For each of these pathogens, relying on only clinical surveillance to generate actionable data is challenging for a number of reasons, including a low ratio of symptomatic cases to overall infections (as is seen for polio), a lack of broadly available gold-standard diagnostic technology (such as for typhoid, cholera, hepatitis E and hepatitis A), and inefficiency of genomic sequencing at the clinic level (which has been the case for SARS-CoV-2 and measles).

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Fig. 1: Use cases may drive measurement goals and environmental surveillance system design.

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Acknowledgements

We thank all participants in the environmental surveillance working group (A. Shaw, C. Troman, J. Akello, N. Grassly, A. Sekhar, A. Tatem, A. Debes, A. Handley, A. Burgos Gutierrez, A. Chaudhuri, B. Lepene, B. Pyne, B. White, C. Uzzell, C. Tato, C. Walder, D. Larsen, D. Blazes, D. Bilgin, D. Boyle, D. Abraham, M. Rahman, D. Steele, E. Karlsson, F. Ishtiaq, F. Qamar, J. Fitzner, G. Smith, G. Abbam, G. Kang, H. Bennett, H. Abdullahi, H. Stembridge, I. Nisar, I. Kartika, I. Blake, I. Liachko, J. Golding, J. Bines, J. John, J. Gauld, J. Dennehy, J. Levy, J. Rigby, J. Trotta, K. O’Reilly, K. Kalantar, K. Barnes, K. McCarthy, K. Porter, K. Vannice, K. Menge, K. Paul Wilkerson, K. Laserson, L. Mhlanga, L. von Tobel, L. Okoko, M. Matus, M. Venter, M. Diamond, K. Medlicott, M. Morrison, M. Oberholzer, M. Taniuchi, M. Yousif, N. Feasey, N. Thomson, N. Soffer, M. Owusu, P. Hart, R. Zellweger, R. Barbero, S. Dolan, S. Twumasi-Ankrah, S. Meschke, S. Harris, S. Magnet, S. Grow, S. Rudd, S. Kroiss, S. Kumar, S. Vouillamoz, T. Shirin, T. Saiyed, V.R. Mohan, V. Oktaria, V. Seaman, V. Moeder, B. Yaffe and Y. Adu-Sarkodie), which comprises attendees at the Environmental Surveillance for Public Health Impact meeting, organized by the Bill & Melinda Gates Foundation.

Author information

Authors and Affiliations

  1. Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK

    Alexander G. Shaw, Catherine Troman, Joyce Odeke Akello, Nicholas Grassly, Christopher Uzzell & Isobel Blake

  2. Centre for Mathematical Modeling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK

    Kathleen M. O’Reilly

  3. Bill & Melinda Gates Foundation, Seattle, WA, USA

    Jillian Gauld, Stephanie Grow, Duncan Steele, David Blazes, Supriya Kumar, Amrita Sekhar, Kimberly Porter, Kirsten Vannice, Lungi Okoko, Michelle Morrison, Samantha Dolan, Simon Harris, Steve Kroiss & Vincent Seaman

  4. Aga Khan University, Karachi, Pakistan

    Farah Naz Qamar & Imran Nisar

  5. Asian Development Bank, Mandaluyong, Philippines

    Christian Walder

  6. Bill & Melinda Gates Foundation, New Delhi, India

    Amrita Sekhar & Kayla Laserson

  7. BioBot, Cambridge, MA, USA

    Mariana Matus

  8. Swasti, The Health Catalyst, Bengaluru, India

    Angela Chaudhuri

  9. Centre for Cellular and Molecular Platforms, Bengaluru, India

    Taslimareif Saiyed

  10. Ceres Nanosciences, Manassas, VA, USA

    Ben Lepene & Robbie Barbero

  11. Chan Zuckerberg Biohub, San Francisco, CA, USA

    Cristina M. Tato & Katrina Kalantar

  12. Chan Zuckerberg Initiative, Redwood City, CA, USA

    Katrina Kalantar

  13. Christian Medical College, Vellore, India

    Dilip Abraham, Gagandeep Kang, Jacob John & Venkata Raghava Mohan

  14. Chromacode, Carlsbad, CA, USA

    Karen Menge

  15. City University of New York, New York, NY, USA

    John Dennehy

  16. Duke-NUS Medical School, Singapore, Singapore

    Gavin J. D. Smith

  17. European Commission, Health Emergency Preparedness and Response Authority, Brussels, Belgium

    Ana Burgos Gutierrez

  18. Illumina, San Diego, CA, USA

    Damla Bilgin, Michael Oberholzer, Nitzan Soffer & Vanessa Moeder

  19. Institut Pasteur du Cambodge, Phnom Penh, Cambodia

    Erik Karlsson

  20. Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh

    Mahbubur Rahman & Tahmina Shirin

  21. International Vaccine Institute, Seoul, Republic of Korea

    Raphaël M. Zellweger

  22. Johns Hopkins University, Baltimore, MD, USA

    Amanda Debes

  23. Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Michael Owusu, Sampson Twumasi-Ankrah & Yaw Adu-Sarkodie

  24. Liverpool School of Tropical Medicine, Liverpool, UK

    Jonathan Rigby, Kayla Barnes & Nicholas Feasey

  25. Malawi-Liverpool-Wellcome Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi

    Jonathan Rigby, Kayla Barnes & Nicholas Feasey

  26. Moderna, Cambridge, MA, USA

    Hamilton Bennett

  27. Murdoch Children’s Research Institute, Melbourne, Victoria, Australia

    Amanda Handley & Julie Bines

  28. National Institute for Communicable Diseases, Johannesburg, South Africa

    Kerrigan McCarthy & Mukhlid Yousif

  29. Novel-T, Geneva, Switzerland

    Lukas von Tobel & Stephane Vouillamoz

  30. Oxford Nanopore Technologies, Oxford, UK

    Stephen Rudd

  31. PATH, Seattle, WA, USA

    David Boyle & Sophie Magnet

  32. Revvity, Waltham, MA, USA

    Gisela Abbam

  33. Phase Genomics, Seattle, WA, USA

    Ivan Liachko

  34. South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa

    Laurette Mhlanga

  35. Wellcome Sanger Institute, Hinxton, UK

    Nicholas Thomson

  36. The Scripps Research Institute, La Jolla, CA, USA

    Joshua I. Levy

  37. Skoll Foundation, Palo Alto, CA, USA

    Ben Pyne & Kathie Paul Wilkerson

  38. Syracuse University, Syracuse, NY, USA

    David Larsen

  39. Tata Institute for Genetics and Society, Bengaluru, India

    Farah Ishtiaq

  40. Thermo Fisher Scientific, Waltham, MA, USA

    Joshua Trotta

  41. UK Health Security Agency, London, UK

    Helen Stembridge

  42. Centre for Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

    Indah Kartika Murni & Vicka Oktaria

  43. Centre for Viral Zoonoses, Department of Medical Virology, University of Pretoria, Pretoria, South Africa

    Marietjie Venter

  44. University of Southampton, Southampton, UK

    Andy Tatem

  45. University of Virginia, Charlottesville, VA, USA

    Mami Taniuchi

  46. University of Washington, Seattle, WA, USA

    John Scott Meschke

  47. Verily Life Sciences, South San Francisco, CA, USA

    Bradley J. White & Benjamin Yaffe

  48. Wellcome Trust, London, United Kingdom

    Josie Golding & Peter Hart

  49. World Health Organization, Brazzaville, Congo

    Hamisu Abdullahi

  50. World Health Organization, Geneva, Switzerland

    Kate Medlicott

  51. World Health Organization, Berlin, Germany

    Julia Fitzner

Authors
  1. Alexander G. Shaw
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  2. Catherine Troman
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  3. Joyce Odeke Akello
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  4. Kathleen M. O’Reilly
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  5. Jillian Gauld
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  6. Stephanie Grow
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  7. Nicholas Grassly
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  8. Duncan Steele
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  9. David Blazes
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  10. Supriya Kumar
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Consortia

The Environmental Surveillance Working Group

  • Farah Naz Qamar
  • , Imran Nisar
  • , Christian Walder
  • , Amrita Sekhar
  • , Kimberly Porter
  • , Kirsten Vannice
  • , Kayla Laserson
  • , Lungi Okoko
  • , Michelle Morrison
  • , Samantha Dolan
  • , Simon Harris
  • , Steve Kroiss
  • , Vincent Seaman
  • , Mariana Matus
  • , Angela Chaudhuri
  • , Taslimareif Saiyed
  • , Ben Lepene
  • , Robbie Barbero
  • , Cristina M. Tato
  • , Katrina Kalantar
  • , Dilip Abraham
  • , Gagandeep Kang
  • , Jacob John
  • , Venkata Raghava Mohan
  • , Karen Menge
  • , John Dennehy
  • , Gavin J. D. Smith
  • , Ana Burgos Gutierrez
  • , Damla Bilgin
  • , Michael Oberholzer
  • , Nitzan Soffer
  • , Vanessa Moeder
  • , Catherine Troman
  • , Joyce Odeke Akello
  • , Nicholas Grassly
  • , Christopher Uzzell
  • , Isobel Blake
  • , Alexander G. Shaw
  • , Erik Karlsson
  • , Mahbubur Rahman
  • , Tahmina Shirin
  • , Raphaël M. Zellweger
  • , Amanda Debes
  • , Michael Owusu
  • , Sampson Twumasi-Ankrah
  • , Yaw Adu-Sarkodie
  • , Jonathan Rigby
  • , Kayla Barnes
  • , Nicholas Feasey
  • , Kathleen M. O’Reilly
  • , Hamilton Bennett
  • , Amanda Handley
  • , Julie Bines
  • , Kerrigan McCarthy
  • , Mukhlid Yousif
  • , Lukas von Tobel
  • , Stephane Vouillamoz
  • , Stephen Rudd
  • , David Boyle
  • , Sophie Magnet
  • , Gisela Abbam
  • , Ivan Liachko
  • , Laurette Mhlanga
  • , Nicholas Thomson
  • , Joshua I. Levy
  • , Ben Pyne
  • , Kathie Paul Wilkerson
  • , David Larsen
  • , Farah Ishtiaq
  • , Joshua Trotta
  • , Helen Stembridge
  • , Indah Kartika Murni
  • , Vicka Oktaria
  • , Marietjie Venter
  • , Andy Tatem
  • , Mami Taniuchi
  • , John Scott Meschke
  • , Bradley J. White
  • , Benjamin Yaffe
  • , Josie Golding
  • , Peter Hart
  • , Hamisu Abdullahi
  • , Kate Medlicott
  • , Julia Fitzner
  • , Jillian Gauld
  • , Stephanie Grow
  • , Duncan Steele
  • , David Blazes
  •  & Supriya Kumar

Corresponding author

Correspondence to Supriya Kumar.

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The authors declare no competing interests.

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Shaw, A.G., Troman, C., Akello, J.O. et al. Defining a research agenda for environmental wastewater surveillance of pathogens. Nat Med 29, 2155–2157 (2023). https://doi.org/10.1038/s41591-023-02457-7

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  • DOI: https://doi.org/10.1038/s41591-023-02457-7

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