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Wastewater is an invaluable source of information about human lifestyle and health. This information can be used by public health authorities to monitor and improve the health of their communities.

Applications

The great advantage of wastewater-based epidemiology resides in the fact that with only a few wastewater samples, and in a completely anonymised way, one can obtain information about the overall lifestyle and health status of an entire population. For this reason, this approach has been applied in numerous fields, such as monitoring illicit drug use, human exposure to environmental contaminants or monitoring the circulation of pathogens such as SARS-CoV-2.

Illicit drugs monitoring – Best practice protocol

Monitoring illicit drug use is one of the most known and established applications of wastewater-based epidemiology. The approach relies on the measurement of specific markers (i.e., illicit drugs or their urinary metabolites) in wastewater samples. Measured concentrations can be then “back-calculated” to amounts of illicit drugs initially consumed.
For this specific application, we have established a best practice protocol which provides guidance about sampling, sample handling, chemical analysis, back-calculation and data reporting. A lot of the information reported here is relevant also for other applications described below.
Publication A: Evaluation of uncertainties
Publication B: Assessing illicit drugs in wastewater
Photo: KWR, Nieuwegein NL

Ethics

One of the great advantages of wastewater-based epidemiology is that it is a non-invasive and anonymized approach, which allows to collect health related information about thousands or hundreds of thousands of people with only a few samples. Nevertheless, ethical guidelines have been established to help researchers and public health authorities in developing monitoring programs which respect these principles.
Publication A: SCORE’s ethical guidelines
Publication B: Development of ethical guidelines for WBE

Pharmaceuticals

Similarly to the case of illicit drugs, the consumption of a broad range of pharmaceuticals (e.g., pain killers such as opioids, erectile dysfunction medications and antibiotics), can be monitored through the analyses of specific markers in wastewater. If compared to available prescription data, results from wastewater analysis can help determine medication adherence and/or whether there is a non-accounted black market.
Publication A: Biomarkers in wastewater as source of information
Publication B: Antibiotics and resistance genese in wastewater

Exposure to environmental and food contaminants

Humans are constantly exposed to a broad range of contaminants which can have negative effects on their health. Conventionally, exposure to these chemicals is assessed through the analysis of specific markers in biological matrices (e.g., urine, blood) collected from a large number of individuals. Although very important, these studies are logistically very complex and time consuming, in particular if the goal is to follow exposure over time. Wastewater-based epidemiology can be a complementary tool to assess community-wide exposure because some of these markers can also be measured in wastewater and can hence be used to follow exposure over time and in different locations.
Publication A: Exposure to pesticides
Publication B: Exposure to flame retardants

Population size

One of the challenges of wastewater-based epidemiology studies is to have reliable and updated data about the number of people in the catchment under study. This is important because the size of a population can vary over time, for instance due seasonal fluctuations (e.g., holiday periods) or due to long-term changes (e.g., structural increase or decrease in the number of inhabitants). These changes can mask or exaggerate trends in markers measured in wastewater-based epidemiology studies. In fact, one might observe higher or lower levels of a given marker in wastewater, but this might be simply due to an increase or a decrease in the number of people present when collecting samples. Various strategies have been proposed to monitor population dynamics. These rely on the measurement of specific markers in collected wastewater samples, mobile phone data, or a combination of these.
Publication A: Mobile phone data and other markers
Publication B: Online ammonium monitoring

Infectious diseases

In the recent COVID19 outbreak, wastewater-based epidemiology has played an important role as it has been used to monitor the circulation of SARS-CoV-2 in communities. In fact, similarly to chemical analyses, molecular methods such as quantitative polymerase chain reaction (qPCR) or next generation sequencing (NGS) can be used to track human pathogens in wastewater. This information can be used to determine if a certain pathogen is present in a community, if its levels are increasing (or decreasing) and, combined with other epidemiological data, can help better understand its circulation in the population.

This approach has been widely implemented to monitor the COVID19 virus, however it can be used for potentially any human pathogen which is eliminated through faeces and/or urine. In fact, this approach has been used to monitor the circulation of other viruses, such as the poliovirus, but also to assess antimicrobial resistance (AMR).

Publication A: Wastewater surveillance database for SARS-CoV-2
Publication B: Wastewater and the fight against COVID-19

Want to participate?

We are always looking for partners willing to participate and to contribute to the SCORE network in order to further develop wastewater-based epidemiology.