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Wastewater surveillance for infectious disease preparednessThe University of Oklahoma Wastewater Based Epidemiology (OU WBE) team highlights successes from their three years of wastewater surveillance in Oklahoma & how this surveillance approach can be used as next-level monitoring for infectious disease preparedness. The OU WBE team, founded by Bradley Stevenson, Jason Vogel, and Katrin Gaardbo Kuhn in response to the COVID-19 pandemic in Summer 2020, has expanded to one of the most extensive wastewater monitoring networks in the world with a team that has included over 50 faculty, students and staff. In a paper published in 1942, Drs. James Trask and John Paul described a study to detect poliovirus in wastewater samples collected in New York and New Haven. They concluded, “It is likely that the periodic sampling of sewage for pathogenic viruses or bacteria may be a method of epidemiological value”. (1) Since then, wastewater surveillance has been used to detect sporadic outbreaks or clusters of various infectious pathogens, reaching new levels of routine utilization during the COVID-19 pandemic.(2) 

ABSTRACT Wastewater-based epidemiology (WBE) expanded rapidly in response to the COVID-19 pandemic. As the public health emergency has ended, researchers and practitioners are looking to shift the focus of existing wastewater surveillance programs to other targets, including bacteria. Bacterial targets may pose some unique challenges for WBE applications. To explore the current state of the field, the National Science Foundation-funded Research Coordination Network (RCN) on Wastewater Based Epidemiology for SARS-CoV-2 and Emerging Public Health Threats held a workshop in April 2023 to discuss the challenges and needs for wastewater bacterial surveillance. The targets and methods used in existing programs were diverse, with twelve different targets and nine different methods listed. Discussions during the workshop highlighted the challenges in adapting existing programs and identified research gaps in four key areas: choosing new targets, relating bacterial wastewater data to human disease incidence and prevalence, developing methods, and normalizing results. To help with these challenges and research gaps, the authors identified steps the larger community can take to improve bacteria wastewater surveillance. This includes developing data reporting standards and method optimization and validation for bacterial programs. Additionally, more work is needed to understand shedding patterns for potential bacterial targets to better relate wastewater data to human infections. Wastewater surveillance for bacteria can help provide insight into the underlying prevalence in communities, but much work is needed to establish these methods. IMPORTANCEWastewater surveillance was a useful tool to elucidate the burden and spread of SARS-CoV-2 during the pandemic. Public health officials and researchers are interested in expanding these surveillance programs to include bacterial targets, but many questions remain. The NSF-funded Research Coordination Network for Wastewater Surveillance of SARS-CoV-2 and Emerging Public Health Threats held a workshop to identify barriers and research gaps to implementing bacterial wastewater surveillance programs.