Top 5 Takeaways

1. National Wastewater Surveillance System (NWSS): Launched by the CDC in September 2020, NWSS coordinates wastewater surveillance programs to support the COVID-19 response across the United States.
2. Early Detection: Wastewater surveillance can detect SARS-CoV-2 infection trends before other COVID-19 metrics, such as case reports and hospital admissions, providing early warnings for public health interventions.
3. State Implementations: Ohio and Utah have effectively used wastewater surveillance data to guide public health actions, allocate resources, and validate clinical case data.
4. Data Integration and Analysis: NWSS provides a centralized platform for data submission, analysis, and visualization, ensuring standardized and timely information for public health decision-making.
5. Limitations: Wastewater surveillance has limitations, including its inability to cover areas not served by municipal sewer systems and challenges in communities with transient populations.

Original Article Author and Citation

Corresponding Author

Amy E. Kirby, agk1@cdc.gov

Suggested Citation

Kirby AE, Walters MS, Jennings WC, et al. Using Wastewater Surveillance Data to Support the COVID-19 Response — United States, 2020–2021. MMWR Morb Mortal Wkly Rep 2021;70:1242–1244. DOI: http://dx.doi.org/10.15585/mmwr.mm7036a2

Summary

Wastewater surveillance measures pathogen levels in wastewater to evaluate community-level infection trends and support public health interventions. The CDC’s National Wastewater Surveillance System (NWSS) was launched in September 2020 to coordinate these efforts across the United States. As of August 2021, NWSS includes 37 states, four cities, and two territories. This report highlights the use of wastewater surveillance data in Ohio and Utah to generate alerts, allocate testing resources, and refine health messaging. Wastewater surveillance can detect SARS-CoV-2 trends before traditional metrics, providing early warnings for public health actions.

Methods

The NWSS framework involves health departments coordinating sample collection and laboratory testing, uploading data to a CDC platform for analysis, and using findings to guide public health actions. The platform performs automated data quality checks, adjusts SARS-CoV-2 concentrations, and classifies trends. Data visualization is available via a dashboard for public health departments. Laboratories prepare samples, concentrate and extract RNA, and measure SARS-CoV-2 RNA concentrations using optimized methods for wastewater.

Discussion

Wastewater surveillance has proven valuable in guiding COVID-19 response efforts by providing early warnings and supporting public health actions. Ohio and Utah have effectively used wastewater data to allocate resources and validate clinical case data. However, limitations include the inability to cover areas not served by municipal sewer systems and challenges in transient communities. NWSS aims to expand participation and build capacity for future pandemic preparedness.

Conclusion

Wastewater surveillance is a robust tool for monitoring community-level SARS-CoV-2 infection trends and supporting public health interventions. The NWSS provides a coordinated and sustainable approach to wastewater surveillance, with potential applications for other pathogens and emerging threats.

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