The National Wastewater Surveillance System represents a coordinated public health innovation developed by the Centers for Disease Control and Prevention (CDC) together with academic institutions, public health networks, wastewater utilities, and other partners. The system leverages wastewater surveillance to detect pathogens anonymously at the community level, extending traditional surveillance that depends on clinical testing and syndromic data. Establishing this capability required new partnerships, validation of laboratory assays for a complex matrix, development of data systems to support real-time information exchange, and investments in workforce capacity and ethical and governance frameworks to guide public health action.
Multiple stakeholders contributed distinct expertise: academic and research groups accelerated assay development and validation; public health laboratories and partners field-tested assays; utility organizations enabled routine sample collection and operational partnerships; and national public health networks supported data standardization, training, and guidance for STLT (state, territorial, local, and tribal) health departments. Together these collaborators built a foundation for a scalable, sustainable surveillance capability that can support responses to current and future infectious disease threats.
A fundamental technical challenge was adapting and validating molecular assays originally designed for clinical samples to the variable wastewater matrix, which can impede assay specificity and sensitivity. Many clinical assays were not openly documented, complicating assessment of potential cross-reactions when applied to wastewater.
Academic and independent research partners, including Research Coordination Network members and the WastewaterSCAN program based at Stanford and Emory Universities, provided rapid research capacity to develop, pilot, and validate assays. State and local public health laboratories concurrently built analytical capabilities and fostered partnerships with utilities and public health stakeholders to expand testing across jurisdictions.
The CDC and partner Centers of Excellence—launched in August 2022 and led by public health departments and academic teams in several states—served as learning laboratories for assay development and evaluation. This collaborative framework emphasized transparent sharing of available assays, continuous improvement informed by field feedback, and nimble deployment of validated tests. The approach supported rapid implementation during outbreaks of monkeypox, influenza A(H5), and measles; for example, assays developed by regional Centers of Excellence and by WastewaterSCAN were quickly validated and distributed to testing partners to support national surveillance efforts.
Effective wastewater surveillance depends on routine sample collection and cooperation from wastewater utilities. The Water Environment Federation acted as a key intermediary between the public health and wastewater sectors, reducing barriers to utility participation and improving data quality.
Activities to build cross-sector relationships included workshops, an annual national wastewater disease surveillance summit, training programs, a community of practice, development of collaboration toolkits for health departments and utilities, podcast and video outreach, a utility-focused website, and initiatives to provide sampling equipment such as autosamplers and flow meters. These efforts facilitated introductions across disciplines, fostered mutual understanding of public health objectives, and helped utilities join surveillance efforts with clearer expectations and practical support.
A robust data infrastructure was required to enable the two-way flow of surveillance information between CDC and STLT health departments—the foundational principle that “effective surveillance is the current and accurate 2-way flow of information among all those who need to know.” Wastewater data include unique elements such as sample-level metadata and sewershed spatial data, and many preexisting public health platforms were not designed to accept this type of input.
CDC established a platform that enables real-time data sharing with STLT partners and the rapid creation of data pipelines for new pathogen targets. This platform aligns with CDC’s Data Modernization Initiative. National public health partners guided data standardization and interoperability, and convened state and territorial stakeholders to ensure data accessibility for public health response. Plain-language data dashboards were developed to help public audiences and jurisdictions visualize trends, interpret findings, and take timely action. These systems emphasized timely, actionable insights and supported communication of results for public health decision making.
Building sustainable wastewater surveillance required expanding public health laboratory and epidemiology capacity. Direct funding supported STLT health departments to establish laboratory testing and surveillance programs. Public health partners contributed mentorship, technical standards, and resources to address ethical considerations for surveillance.
Academic and clinical partners—including the wastewater surveillance Centers of Excellence—offered training in laboratory methods, data interpretation, and strategies for engaging communities and clinicians. Communities of practice created by partner organizations facilitated peer learning among utilities, laboratories, and health departments, enabling new workforce members to share successes, troubleshoot challenges, and standardize best practices across jurisdictions.
The source document indicates a section on Future Challenges but the provided text is truncated before the full content of that section. Specific details about anticipated operational, ethical, governance, funding, or technical challenges and planned responses were not reported in the source excerpt available for this summary. Additional information from the full article would be needed to describe the Future Challenges section comprehensively.
Note on source completeness: This rewrite is based solely on the provided CDC Emerging Infectious Diseases article excerpt. Portions of the original article were not included in the supplied text; where the excerpt truncated content, those missing details are explicitly noted rather than inferred or invented.