This is a summary, written by members of the CITF Secretariat, of:

Parkins MD, Lee BE, Acosta N, Bautista M, Hubert CRJ, Hrudey SE, Frankowski K, Pang XL. Wastewater-based surveillance as a tool for public health action: SARS-CoV-2 and beyond. Clin Microbiol Rev. 2023 December 14; doi:

The results and/or conclusions contained in the research do not necessarily reflect the views of all CITF members.

A CITF-funded study, published in Clinical Microbiology Reviews, provides a thorough overview of the usefulness of wastewater-based surveillance (WBS), during and after the COVID-19 pandemic. This state-of-the art review addresses the heterogeneity of information currently present in the SARS-CoV-2 literature on WBS. The authors conclude that WBS technology is a key tool that can provide valuable insights in studying infectious diseases and informing public health policies. This research was led by Dr. Michael D. Parkins (University of Calgary) and Dr. Xiao-Li Pang (University of Alberta).

The authors discuss and consolidate key information regarding the emerging science of wastewater based epidemiology and the power of this platform technology to provide a leading indicator of SARS-CoV-2 disease dynamics. They then consider how to extend the SARS-CoV-2 model to other pathogens.

Key findings:

  • Wastewater data correlate with COVID-19 clinical disease in the community, including hospitalization and COVID-19 mortality rates, and has been used to effectively predict health resource utilization.
  • While tools have been developed to detect SARS-CoV-2 RNA coming from feces, saliva, sputum, and even urine (to a minor extent) through WBS, there is still a requirement for detailed data further establishing fecal shedding dynamics.
  • Achieving samples that are representative of a specific population requires more information on how best to optimize the various factors involved, including the target water source, sampling device, sampling techniques, etc.
  • Numerous biomarkers have been proposed as normalization benchmarks, but no current candidate meets all the desired characteristics of an ideal biomarker.
  • While there are many available techniques to detect viral genetic material in WBS, the heterogeneity of biological materials in wastewater remains a key challenge.

Overall, this review paper consolidates information on the current infrastructure requirements needed to generate near-real time data on the prevalence and distribution of a target pathogen across space and time. The authors conclude that WBS is a cost-effective and practical tool for public health but requires significant preparatory work for each individual infectious agent to optimize workflows.