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Wastewater & Environmental Surveillance in Low-Resource Settings

By Supriya Kumar (Bill & Melinda Gates Foundation, USA) and Kerrigan McCarthy (National Institute for Communicable Diseases, South Africa)

Wastewater & Environmental Surveillance (WES) has been an invaluable resource in the polio eradication initiative, and more recently, during the SARS-CoV-2 (SC2) pandemic. WES detection has alerted public health authorities to the introduction of poliovirus or SC2 into communities. Further,  genomic sequence data generated directly from sewage has shed light on global poliovirus transmission, and on the spread of variants of concern of SC2. Detection of these pathogens has guided authorities to implement appropriate public health interventions to safeguard public health. Detection of poliovirus in communities leads to vaccination campaigns, whilst detection of increasing SC2 levels in wastewater has led to  enhanced risk communication in communities during the pandemic.

Building on the potential for WES in poliovirus and SC2 surveillance, multiple countries and researchers are developing WES methods for additional pathogens. Interest has burgeoned in validating WES methods for vaccine preventable disease surveillance for diseases such as  measles, rubella, typhoid and cholera, as well as for pathogens that have or have potential to cross over from animals into human populations and cause epidemics, such as Mpox, H5N1 influenza, Lassa, and other zoonoses.

At the Gates Foundation, we have been working with global partners to explore the utility of WES for multiple pathogens in low-resource settings, especially in low- and middle-income countries (LMICs). Researchers have developed and validated i) field and lab tools to enhance detection of pathogens in wastewater, ii) laboratory sequencing methods and bioinformatics tools to support sequencing and genomic analysis of pathogens from sewage, and iii) modeling and analytic methods to interpret the public health significance of WES data, and iv) reporting and communication tools to facilitate utilization of data by the public and by public health authorities for decision-making.

Country public health institutes and researchers are implementing WES for multiple pathogens in Africa and Asia, providing valuable evidence regarding the strengths and challenges of WES in not only communities with access to sewered sanitation, but also low-resource settings with only open drains and rivers to carry human-shed pathogens away from households. Standards for data collection and sharing, developed in consultation with multiple implementing groups, allows WES data to be analyzed alongside more traditional infectious disease surveillance data to provide public health decision-makers with information needed to intervene and prevent disease. We believe that open sharing of learnings from these groups provides the substrate for development of WES guidelines at the WHO, which could then inform further implementation in low-resource settings.

With its commitment to open, ethical and reproducible research, the PLOS journalsare the ideal venue for this interdisciplinary research. We are therefore excited to announce a collection on Wastewater & Environmental Surveillance for Infectious Diseases in Low-resource Settings to cover this scope for the future.

The PLOS journals accepting contributions for this collection include:

Researchers and practitioners interested in contributing to this collection should submit their research articles by 31 July 2024. Topics include, but are not limited to: 

  • Development and validation of methods and tools for WES of pathogens beyond polio and SC2 (field, lab, or bioinformatics tools)
  • Modeling and analytic frameworks for WES data (including cost analyses, or value of information analyses)
  • Pathogen prioritization frameworks for WES
  • Implementation of WES in LMICs (statistical analysis plans or results from implementation programs)
  • Development of standards for WES data collection and sharing

For questions about the collection or to express interest in contributing, please contact:

Ready to submit your research to this collection in a PLOS journal? Follow our step-by-step guide to the submission process for your relevant journal (found under the ‘Publish’ tab at the top of the journal homepage and selecting the ‘Submit Now’ option under the ‘Submissions’ sub-heading), and ensure you include the name of the collection in the relevant free-text field during the submission process.

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