Wastewater Based Epidemiology - Flyer

WASTEWATER-BASED EPIDEMIOLOGY (WBE) WHAT IS IT AND HOW CAN IT HELP PUBLIC HEALTH IN INDIAN COUNTRY?

WHAT is Wastewater-Based Epidemiology (WBE)?

Wastewater surveillance, also known as wastewater-based epidemiology (WBE), is the monitoring of pathogens (e.g., viruses), as well as pharmaceuticals and other chemicals by testing sewage or wastewater. Wastewater includes water from a household or building (such as toilets, showers, and sinks) that can contain human feces, as well as water from non-household sources (such as rain and industrial use). CDC 2023 Public health officials can use WBE to monitor for outbreaks, track trends in the community, identify threats (e.g., antibiotic-resistant bacteria) and, in response, support the mobilization of public health resources to the affected communities. U.S. Government Accountability Office INFECTIOUS DISEASES THAT CAN BE TRACKED BY WBE (CDC):

SARS CoV-2 Influenza A & B RSV Andenovirus 40/41

Norovirus Candida auris Monkey Pox Shinga-toxin producing E. Coli

Because wastewater surveillance does not require people to seek testing from a healthcare provider and can be representative of large portions of a community, it gives public health officials a way to detect and characterize infection trends in a non-invasive, timely, and cost-effective way.

Network of Water-Based Epidemiology (NWBE) WEF

7-12 Days

WBE has been shown to detect infectious diseases in the community at least 7 days before clinical testing

“Wastewater monitoring is an efficient way to empower historically underserved communities with health insights. With this data in hand, Tribal leaders, affiliated health systems and community members can better advocate for the resources needed to respond to existing and future disease threats.”

- Megan Diamond, a Health Initiative Manager & WWS Lead at The Rockefeller Foundation.

HOW DOES WBE WORK? Everybody Poops People can shed viruses and other bioindicators in their poop, even if they are asymptomatic (not showing sign/symptoms). The poop is flushed into the sewage system.

Sewershed Samples Wastewater from a sewershed (the community area served by a wastewater collection system) is collected at man-holes or other sampling sites that before it flows into a treatment plant.

Sample Analysis The samples are then sent to public health laboratories for RNA analysis and other sampling measures to detect the presence of pathogens, substances, or other health concerns. The OU Lab handles all the wastewater sampling in Oklahoma at this time.

Public Health Data & Actions The lab then reports the results to the health department for use in epidemiological action response. The results are available to the public through online dashboards as well as individualized reports to public health officials in the different sampling areas. Actions can include: recommendations on wearing masks, vaccination protocols, social distancing, and other actions.

WWW.SPTHB.ORG

BENEFITS OF WBE:

LIMITS OF WBE:

WBE is anonymous.

Responses to a 2023 SPTHB WBE survey showed that data sovereignty was not an issue among Tribal participants since samples are a collection of a large community and not an individual (i.e. athome Covid-19 test).

WBE is a NOT a stand-alone health tool.

No single method of detecting and tracking pathogens is a silver bullet. “WBE cannot replace clinical surveillance, but it can provide another data source for decision-making,” - Dr. Amy Kirby and Dr. Mia Mattioli

WBE can show early detection of diseases.

People infected with pathogens can shed the virus in their feces, even if they don’t have symptoms. This allows WBE to serve as an early warning that a pathogen is spreading in a community up to 1-2 weeks before clinical testing when symptoms may occur

WBE Sampling is limited to locations with a central wastewater system in Oklahoma.

Currently, WBE samples in Oklahoma are taken from manhole locations found within a central wastewater system. Only 50% of residents in OK are on a central wastewater system (ODEQ).

Sampling from communal lagoons and septic systems are not viable at this time.

WBE can be less expensive than clinical testing.

You can gain insights into hundreds of people with a single non-invasive specimen. Therefore, making WBE a more equitable pathogen surveillance approach to overcome barriers of traditionally underserved communities -Rockefeller Foundation

WBE is NOT easy to coordinate.

It takes close coordination among public health agencies, environmental engineers, analytical laboratories, and wastewater utilities to generate reliable data and support appropriate interpretation and use of data to provide to the general public.

WBE has potential to track other emerging public health threats.

WBE can also be used to detect and respond to other infectious disease threats like antibiotic resistance, foodborne diseases, pathogen variants, stress levels, and detection of illicit drugs.

Applications of WBE are ever changing and growing.

There are many factors that can affect WBE samples.

WBE samples are of an entire sewershed can be affected by several factors, this can include: nonhuman industrial inputs, facility waste outputs, temperature, seasonal runoff, tourism rates, heat, variations in flow, and long sample transportation times, to name a few.

INTERESTED IN LEARNING MORE ABOUT WBE? Check out these resources: CDC NWSS: https://www.cdc.gov/nwss/index.html CDC Train Course: https://www.train.org/cdctrain/course/1091714/details Oklahoma SARS CoV-2 Dashboard: https://www.arcgis.com/apps/dashboards/51657c2138 6d4f1a962b1853c76ec589 OSHD Viral View for Respiratory Diseases: https://oklahoma.gov/health/healtheducation/acute-disease-service/diseaseinformation/viral-view.html National Water-Based Epidemiology: https://nwbe.org/?page_id=77

Rockefeller Foundation Tribal WBE: https://www.rockefellerfoundation.org/case-study/bringingwastewater-tracking-to-tribal-lands-to-protect-families-andelders/ Houston NWSS CoE Resources: https://www.houwastewater-epi.org/ Houston NWSS CoE WBE Training Modules: https://www.hou-wastewater-epi.org/educationalresources/wastewater-monitoring-training-modules University of Denver Colorado NWSS CoE: https://www.du.edu/nwsscoe

For more information, contact info@spthb.org