Harnessing Innovation: International Day of Epidemic Preparedness and the Role of Wastewater Surveillance

As we approach the 4-year mark of the beginning of the COVID-19 pandemic, the world reflects on the profound impact this unprecedented crisis has had on global health, economies, and everyday life. On this International Day of Epidemic Preparedness, observed annually on December 27th, we not only commemorate the progress we’ve made since the onset of COVID-19 but also spotlight innovative approaches that have emerged in the ongoing battle against infectious diseases. Among these, wastewater surveillance, coupled with the power of real-time technologies, has reshaped our ability to respond to infectious threats, contributing to our collective efforts to fortify global health defenses. 

Origins of the International Day of Epidemic Preparedness

The International Day of Epidemic Preparedness was established by the United Nations General Assembly in 2020 to honor the work of healthcare professionals and researchers worldwide during the COVID-19 pandemic. It serves as a global platform to raise awareness about the ongoing threats posed by infectious diseases, emphasize the importance of preparedness, and encourage international collaboration to build a more resilient and proactive response to future health crises. 

The Evolution of Epidemic Preparedness

Traditionally, epidemic preparedness relied heavily on clinical diagnoses and individual reporting of symptoms. However, the advent of real-time technologies has ushered in a paradigm shift, enabling us to proactively monitor communities for the presence of pathogens by analyzing wastewater.

In the not-so-distant past, the response to potential epidemics largely depended on the identification of symptomatic individuals seeking medical attention. While this reactive approach has been essential in managing outbreaks, it inherently suffers from delays, allowing infectious diseases to gain a foothold in communities before decisive action can be taken. By the time symptomatic cases were identified, the infectious agent might have already spread within the community, making containment more challenging and necessitating more extensive and resource-intensive measures. 

Moreover, the reliance on individual reporting posed challenges in situations where carriers of the disease displayed mild or no symptoms, contributing to the silent spread of infections within communities. This phenomenon was notably evident in the H1N1 influenza pandemic in 2009, where a significant portion of infected individuals exhibited mild symptoms or were asymptomatic (Hong-Wu et al., 2015).

While wastewater surveillance is not a new concept, as epidemiologists have utilized wastewater to track and contain disease outbreaks since the 1940s (Schmidt, 2020), its pivotal moment came in the context of the COVID-19 pandemic. The SARS-CoV-2 virus, responsible for COVID-19, was found to be shed in the feces of infected individuals. This discovery prompted researchers worldwide to explore wastewater as a potential tool for early detection of outbreaks. 

As the pandemic unfolded, various studies demonstrated the feasibility of using wastewater surveillance to detect the presence of the virus in communities before clinical cases were reported. Governments and municipalities started incorporating wastewater monitoring into their epidemic preparedness and response plans, propelling this strategy into the mainstream of public health. 

Wastewater Surveillance: A Powerful Tool

Wastewater surveillance involves the analysis of sewage water to detect traces of viruses, bacteria, or genetic material shed by the population. This approach offers a unique vantage point, as it reflects the collective health of an entire community. Pathogens shed by individuals, whether symptomatic or not, enter the sewage system, providing an early indication of the presence of infectious agents, often before clinical cases emerge. 

Early detection of pathogens in wastewater provides a crucial window of opportunity for public health authorities to intervene before clinical cases emerge. By analyzing trends in pathogen levels, experts can anticipate outbreaks, allocate resources efficiently, and implement targeted interventions, such as widespread testing, contact tracing, and public health messaging.

Moreover, real-time wastewater surveillance contributes to a global network of early warning systems. The sharing of data between communities and nations fosters a collaborative approach to epidemic preparedness, breaking down borders in the face of infectious threats. This interconnectedness enables a faster and more coordinated response, reinforcing the idea that the health of one community is intricately linked to the well-being of the global population.

The Role of Real-Time Technologies

Advanced technologies, such as quantitative polymerase chain reaction (qPCR) and next generation sequencing (NGS), have spearheaded a revolution in wastewater surveillance. These real-time analytical tools represent a seismic shift in our ability to swiftly and precisely identify specific pathogens present in sewage water. Furthermore, the integration of artificial intelligence (AI) and machine learning (ML) has played a pivotal role in transforming the landscape of wastewater analysis, fostering rapid advancements in accuracy and efficiency.

qPCR has been a cornerstone in the evolution of wastewater surveillance, amplifying genetic material to provide a quantitative measure of the abundance of specific pathogens in sewage water. Its real-time capabilities enable scientists to monitor changes in pathogen levels dynamically, offering valuable insights into the dynamics of infectious diseases within a community. The genetic signatures of bacteria, viruses, and other microorganisms that are detected with PCR come from next generation sequencing, which allow for the high-throughput sequencing of entire genomes. By providing a holistic view of genetic material present in sewage, NGS enhances our ability to identify not only known pathogens but also emerging or unknown threats.

Furthermore, the integration of artificial intelligence and machine learning into wastewater surveillance has elevated the field to new heights, bringing a level of automation that was previously unattainable. AI and ML algorithms can analyze vast datasets derived from wastewater samples, discern patterns, and identify subtle indicators of potential outbreaks. This not only accelerates the detection process but also enhances the accuracy of results, enabling a more nuanced understanding of the microbial composition in wastewater.

Benefits of Wastewater Surveillance

The advantages of wastewater surveillance extend beyond early detection. It provides a broader understanding of the prevalence and spread of diseases within communities, aiding in effective resource allocation and public health decision-making. By complementing traditional surveillance methods, wastewater monitoring offers a cost-effective and non-invasive means to monitor population health on a larger scale.

Early Detection of Outbreaks

Wastewater surveillance serves as an early warning system, enabling the detection of pathogens in sewage before clinical cases arise. This proactive approach allows for swift public health interventions, such as targeted testing, contact tracing, and the implementation of preventive measures, reducing the impact of infectious diseases on communities. From implementing targeted public health measures to guiding vaccination strategies, the insights gained from wastewater monitoring enhance the decision-making process, ultimately leading to more effective epidemic preparedness and response.

Comprehensive Community Health Monitoring

Beyond early detection, wastewater surveillance provides a comprehensive overview of the health of entire communities. One of the notable advantages of wastewater surveillance is its ability to capture asymptomatic cases. As individuals who do not display symptoms can still shed pathogens, traditional clinical surveillance may miss these silent carriers. This holistic understanding of the prevalence and spread of diseases is invaluable for public health officials in developing informed strategies for disease control. 

Efficient Resource Allocation

Wastewater surveillance facilitates more efficient resource allocation by pinpointing specific areas with higher pathogen concentrations. This data-driven approach enables public health authorities to allocate testing resources, medical supplies, and personnel to areas at higher risk, optimizing the use of limited resources in a targeted manner.

Non-Invasive and Cost-Effective Monitoring

Complementing traditional surveillance methods, wastewater monitoring is a non-invasive and cost-effective means of monitoring population health on a larger scale. Unlike individual clinical testing, which can be resource-intensive and may not capture asymptomatic cases, wastewater surveillance provides a broader and more economical overview of community health.

Global Collaboration and Data Sharing

Wastewater surveillance fosters global collaboration by providing a common metric for assessing the prevalence of pathogens across regions. The sharing of data between communities and nations enhances collective preparedness, allowing for a more coordinated and collaborative response to infectious diseases on a global scale.

The COVID-19 Pandemic and Airport Wastewater Surveillance: A Case Study

The COVID-19 pandemic highlighted the utility of wastewater surveillance as a crucial tool in monitoring the spread of the virus. In response to the challenges posed by the pandemic, the NRC-IRAP, in collaboration with the Greater Toronto Airports Authority (GTAA), identified the need for an advanced wastewater surveillance program at Toronto Pearson Airport. Three biotech companies, including Kraken Sense, were selected to conduct comprehensive testing for SARS-CoV-2 variants in airport wastewater.

Kraken Sense implemented their KRAKEN™ automated real-time PCR device to monitor liquid-based samples for bacteria and viruses. This cutting-edge approach allowed for the early detection and continuous monitoring of pathogen surges in the wastewater, offering a proactive tool in the fight against COVID-19. Over a period of six months, Kraken Sense autonomously conducted wastewater sampling at Toronto Pearson Airport, providing a robust dataset for analysis. The non-intrusive testing methodology did not disrupt passenger traffic, providing a seamless integration of biosurveillance efforts into the airport's daily operations. This approach not only supported public health initiatives but also ensured the continuous safety of airport facilities.

Conclusion

As we commemorate the International Day of Epidemic Preparedness, we recognize the transformative potential of wastewater surveillance and real-time technologies. By committing to continued research, investment, and community engagement, we can build a world that is responsive to the challenges of today and resilient in the face of tomorrow's uncertainties.

References

Hong-Wu, Z., Jing, Y., Wen-Xian, H., Hong-Jun, L., Lu, P. X., Xiao-Hua, L., Hua, H., Xiao-Ming, M., Lei, Z., Ya-Nan, H., Hao-Peng, W., Qian-Qian, Z., & Ziling, S. (2015). Influenza A (H1N1). Diagnostic Imaging of Emerging Infectious Diseases, 57–76. https://doi.org/10.1007/978-94-017-7363-8_4

Schmidt C. (2020). Watcher in the wastewater. Nature biotechnology, 38(8), 917–920. https://doi.org/10.1038/s41587-020-0620-2