WastewaterSCAN project expands with six new disease targets

Andrew Myers

The Stanford-led WastewaterSCAN project provides groundbreaking research in “wastewater-based epidemiology,” the science of scanning small samples of sewage for viruses, microorganisms and fungi that cause dangerous infectious diseases. The project, in partnership with Emory University and Verily Life Sciences, announced this week that it has detected six new pathogens, bringing its disease target list to the 12 most important seasonal and emerging pathogens currently in the United States.

Providing timely and actionable data through its data dashboards, WastewaterSCAN enables health officials and communities to quickly spot disease patterns and trends so they can make informed choices about how to respond.

“The inclusion of six new pathogens demonstrates the value of wastewater-based epidemiology as a durable public health infrastructure,” said Alexandria Boehm, professor of civil and environmental engineering at Stanford University and WastewaterSCAN principal investigator and project director. “This is WastewaterSCAN and the wastewater epidemic. An important milestone in medical science.”

New disease targets on the WastewaterSCAN roster include parainfluenza, rotavirus, group F adenovirus, enterovirus D68, Candida auris and hepatitis A. With these additions, WastewaterSCAN now tracks three of the most important gastrointestinal diseases in the United States and is the first wastewater-based disease epidemiology program to provide nationwide surveillance of enterovirus D68 and the multidrug-resistant fungus Candida auris .

WastewaterSCAN is also the first nationwide wastewater monitoring program in the United States that extends beyond SARS-CoV-2 (the virus that causes COVID-19 and its variants) to track and publicly share RSV, influenza A and B, mpox, Norovirus and human metapneumovirus. WastewaterSCAN now monitors 12 major respiratory, enteric and emerging infectious diseases, as well as a fungus that poses a significant threat to public health. WastewaterSCAN selected six additional pathogens through close dialogue with public health collaborators across the country.

“By being flexible in responding to known and emerging threats and rapidly rolling out new disease targets, WastewaterSCAN has established robust weather forecasts for infectious diseases,” said Marlene Wolfe, assistant professor of environmental health at Emory University and director of the WastewaterSCAN program. Given the value of the data, we hope to see support for wastewater monitoring continue to grow and more communities use the data to inform individual and collective responses, not only to COVID-19 but also to other general concerns disease.”

More information about wastewater scanning

Throughout the pandemic, the science of studying wastewater for the presence of disease — also known as wastewater-based epidemiology (WBE) — has received increasing attention from public health, governments, local officials and wastewater treatment plants. WastewaterSCAN has partnered with municipal wastewater treatment facilities in more than 180 communities in 37 U.S. states to monitor wastewater for COVID-19, seasonal influenza, RSV and many other viruses. These communities are home to nearly 42 million Americans, accounting for 12% of the U.S. population. This method tests everyone in the community but cannot identify any specific individual. As a philanthropically funded academic project, WastewaterSCAN covers the entire cost of wastewater monitoring for participating communities, including sampling, transportation, and data availability.

WastewaterSCAN collects small samples from each wastewater treatment plant up to three times per week to monitor its partner communities for the presence of disease, often detecting the prevalence of pathogens before citizens develop symptoms or seek medical attention. This early warning system can help public health and government officials assess the relative presence of the disease in their communities—whether infection rates are rising, falling, or staying the same. Ultimately, WastewaterSCAN helps these officials make better, more comprehensive decisions about when and how to act for the benefit of their communities.

WastewaterSCAN also reports data through the National Wastewater Surveillance System, a CDC-coordinated effort to track SARS-CoV-2 in wastewater samples collected across the country. WastewaterSCAN’s protocols and methods are published online and are open source, and the academic paper is available on its website.

WastewaterSCAN adds more information on six new tests:

• Parainfluenza – causes a respiratory infection with cold-like symptoms in infants, young children, the elderly and people with compromised immune systems, but can also lead to more severe lung infections and difficulty breathing.
• Rotavirus – Highly contagious, often affecting unvaccinated children aged 3-5 years, causing diarrhea, vomiting, fever and abdominal pain.
• Group F adenovirus – Causes acute gastroenteritis, causing fever, diarrhea, vomiting, and abdominal pain. In rare cases, cases can become severe, and people who are immunocompromised or have respiratory or heart disease are more susceptible to the virus.
• Enterovirus D68 – A common non-polio enterovirus that can cause respiratory illness – runny nose, sneezing, coughing and body aches. Severe cases may cause wheezing and difficulty breathing. Infants, children and teenagers are most susceptible.
• Candida auris – A yeast that often develops drug resistance and can cause serious illness and, in rare cases, death. C. auris spreads easily among high-risk patients in health care settings. Treatment is possible, but drug-resistant strains of the fungus now exist.
• Hepatitis A – highly contagious viral infection of the liver. Symptoms include tiredness and weakness, sudden nausea and diarrhea, abdominal pain, loss of appetite, and low-grade fever. It can spread asymptomatically.

“The range of diseases tracked by WastewaterSCAN for communities and public health officials demonstrates how useful wastewater surveillance can be as a public health tool at the local, state and federal levels,” Boehm added. “This can help provide information for biosecurity and emerging infections. To inform decision-making in areas such as disease threats.”