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The sampling and analysis of sewage for pathogens and other biomarkers offers a powerful tool for monitoring and understanding community health trends and potentially predicting disease outbreaks. Since the early months of the COVID-19 pandemic, the use of wastewater-based testing for public health surveillance has increased markedly. However, these efforts have focused on urban and peri-urban areas. In most rural regions of the world, healthcare service access is more limited than in urban areas, and rural public health agencies typically have less disease outcome surveillance data than their urban counterparts. The potential public health benefits of wastewater-based surveillance for rural communities are therefore substantial - though so too are the methodological and ethical challenges. For many rural communities, population dynamics and insufficient, aging, and inadequately maintained wastewater collection and treatment infrastructure present obstacles to the reliable and responsible implementation of wastewater-based surveillance. Practitioner observations and research findings indicate that for many rural systems, typical implementation approaches for wastewater-based surveillance will not yield sufficiently reliable or actionable results. We discuss key challenges and potential strategies to address them. However, to support and expand the implementation of responsible, reliable, and ethical wastewater-based surveillance for rural communities, best practice guidelines and standards are needed.
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This content will become publicly available on September 26, 2026
Landscape-scale analysis of raccoon rabies surveillance reveals different drivers of disease dynamics across latitude
When raccoon rabies first invaded the mid-Atlantic United States, epizootics were larger, longer, and more pronounced than those in its historic, more southern, range, suggesting a North-South gradient in disease dynamics. In addition, due to higher raccoon densities and concentrated feeding sources, urban areas might sustain larger epizootics, suggesting an urban-rural gradient might likewise influence dynamics. Here we leverage long-term surveillance data on raccoon rabies, collated by the Centers for Disease Control and Prevention, United States Department of Agriculture, and state and local public health agencies to better understand the role of latitude and urbanness for raccoon rabies epizootiology. Our analysis utilizes surveillance data from the 20 states composing the raccoon rabies enzootic area across 2006–2018. We identified effects of latitude and human population density (a proxy for urbanness) on the county-level probability of detecting raccoon rabies. We find that: 1) in the northeastern US, more samples are submitted in the summer, and more positive results are obtained, albeit with a lower likelihood of a given sample being found to be rabid, while these trends are independent of season at southern latitudes; 2) the association between urbanness and risk of rabies cases varies across latitude, with greater rabies presence in rural vs. urban counties in the south and a more consistent risk across urbanness in the north; and 3) the most consistent predictors of raccoon rabies detection are spatiotemporal effects, suggesting that recent detection of cases in a county or its neighbors are more informative of raccoon rabies dynamics than are general metrics like latitude and urbanness. Statistical and spatial long-term studies like these not only can improve understanding of wildlife disease patterns but can help guide public health and wildlife management efforts in areas most at risk for raccoon rabies virus infection.
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- Award ID(s):
- 2321358
- PAR ID:
- 10644089
- Editor(s):
- Rayner, Simon
- Publisher / Repository:
- PLOS
- Date Published:
- Journal Name:
- PLOS Neglected Tropical Diseases
- Volume:
- 19
- Issue:
- 9
- ISSN:
- 1935-2735
- Page Range / eLocation ID:
- e0013581
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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