The United States National Wastewater Surveillance System, established in 2020, makes timely community-level infectious disease data publicly accessible. The authors examined how the public understands wastewater surveillance (WS) data and how people perceive its importance, using a nationwide cross-sectional survey fielded in August 2025. The goal was to assess definition recognition, ability to interpret a WS graphic, intended protective actions after detections, and open-text perceptions of WS value.
Data were collected via the PN View survey conducted by Porter Novelli Public Services and Big Village from August 22–24, 2025. The voluntary, online survey sampled U.S. adults aged 18 years and older using nonprobability quota sampling; Porter Novelli computed weights to reflect U.S. demographic composition by sex, age, region, race and ethnicity, and education using Current Population Survey proportions. The authors report following Checklist for Reporting Results of Internet E-Surveys guidelines.
Participants selected the WS definition that best matched their understanding, interpreted a figure showing wastewater detections for a hypothetical vaccine-preventable respiratory virus, and indicated actions they would take if that virus were detected in their community. An open-text field solicited opinions on the importance of WS information. Quantitative analyses were weighted and performed in Stata v18.0; free-text responses were analyzed in MAXQDA 24. CDC review deemed the activity not research under the National Center for Emerging and Zoonotic Infectious Diseases Human Subjects Advisor guidance.
The analytic sample included 1,014 participants. Weighted demographic distributions reported: 51.0% female and 48.5% male; 60.8% non-Hispanic White; and 45.9% residing in suburban communities. Approximately half of respondents (50.3%, 95% CI 47.1%–53.5%) correctly identified the definition of WS.
A large majority (83.3%, 95% CI 80.8%–85.5%) correctly interpreted the provided figure depicting wastewater detections of a hypothetical vaccine-preventable respiratory virus, indicating that a clear, intuitive graphic can aid public comprehension. When asked what steps they would take if wastewater data showed the virus present in their community, the most frequently selected responses were:
Respondents could select multiple actions, and the figure in the source summarizes these response distributions with 95% confidence intervals.
Most participants provided open-text responses consistent with viewing WS information about viruses and variants as important. Overall, 79.0% of free-text replies suggested importance. Among 801 respondents who considered WS important, 624 (77.9%) wrote about themes of early detection, outbreak prevention, situational awareness, and protecting family or community safety. Within that subgroup, 79 respondents (12.7%) explicitly mentioned virus strains or vaccination relevance.
Illustrative participant comments in the source include statements that WS “helps detect which viruses are spreading and even identify their variants,” and that WS “[can tell you if the strain of the virus is a new one that you may not have been vaccinated against, and you can take the necessary precautions].” A subset of respondents recommended clear, nonalarming communication when informing the public. Participants who viewed WS as unimportant cited uncertainty about useful actions and beliefs that disease spread is inevitable regardless of surveillance.
The reported awareness level (about half correctly defining WS) is consistent with previous nationwide surveys cited by the authors—48% in 2022, 49% in 2023—and a 2024 five-state survey reporting 56.0% awareness. The high rate of correct interpretation of the example graphic suggests that appropriately designed visuals can improve comprehension of WS outputs.
To maximize usability of WS data for the public, the authors recommend that health agencies provide clear, plain-language explanations of what wastewater surveillance measures, paired with intuitive graphics and pathogen-specific guidance for data interpretation. Offering actionable, practical protective steps when detections occur may empower community members to make informed decisions.
The authors note demographic differences in understanding that could reflect uneven exposure to public health messaging and therefore present opportunities for tailored communication (for example, targeted outreach in rural communities). They also recommend partnering with trusted messengers—media partners, community organizations, and healthcare providers—to amplify and contextualize WS information during periods of increasing infectious disease activity.
Study limitations reported in the source include potential self-selection bias if persons already interested in public health or WS were more likely to participate, and possible measurement error or social desirability bias arising from the open-ended question framing. The source did not report response rates or incentives related to recruitment.
In summary, the August 2025 survey found moderate public awareness of WS, strong ability to interpret an example wastewater-detection graphic, and generally favorable attitudes when respondents were given background information. The authors emphasize the value of plain-language materials, clear visuals, actionable guidance, and tailored outreach to enhance the public utility of wastewater surveillance data.