Research needs for optimising wastewater-based epidemiology monitoring for public health protection

Katie Robins, Anne F.C. Leonard, Kata Farkas, David W. Graham, David L. Jones, Barbara Kasprzyk-Hordern, Joshua T. Bunce, Jasmine M.S. Grimsley, Matthew J. Wade, Andrew M. Zealand, Shannon McIntyre-Nolan

Research output: Contribution to journalArticlepeer-review

12 Citations (SciVal)


Wastewater-based epidemiology (WBE) is an unobtrusive method used to observe patterns in illicit drug use, poliovirus, and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The pandemic and need for surveillance measures have led to the rapid acceleration of WBE research and development globally. With the infrastructure available to monitor SARS-CoV-2 from wastewater in 58 countries globally, there is potential to expand targets and applications for public health protection, such as other viral pathogens, antimicrobial resistance (AMR), pharmaceutical consumption, or exposure to chemical pollutants. Some applications have been explored in academic research but are not used to inform public health decision-making. We reflect on the current knowledge of WBE for these applications and identify barriers and opportunities for expanding beyond SARS-CoV-2. This paper critically reviews the applications of WBE for public health and identifies the important research gaps for WBE to be a useful tool in public health. It considers possible uses for pathogenic viruses, AMR, and chemicals. It summarises the current evidence on the following: (1) the presence of markers in stool and urine; (2) environmental factors influencing persistence of markers in wastewater; (3) methods for sample collection and storage; (4) prospective methods for detection and quantification; (5) reducing uncertainties; and (6) further considerations for public health use.

Original languageEnglish
Pages (from-to)1284-1313
Number of pages30
JournalJournal of Water and Health
Issue number9
Publication statusPublished - 1 Sept 2022

Bibliographical note

The United Kingdom Government (Department of Health and Social Care) fund the sampling, testing, and data analysis of wastewater in England. The Welsh Government (Technical Advisory Cell) funds the sampling, testing, and data analysis of wastewater in Wales. The following funding sources are acknowledged by the contributing authors: ‘National COVID-19 Wastewater Epidemiology Surveillance programme (NE/V010441/1) UKRI-NERC COVID Response (D.W.G., D.L.J., B.K.-H.); ‘Building an Early Warning System for community-wide infectious disease spread: SARS-CoV-2 tracking in Africa via environment fingerprinting’ (EP/V028499/1) GCRF/Newton Fund (B.K.-H.).


  • antimicrobial resistance
  • chemicals
  • metabolites
  • pathogens
  • public health wastewater-based epidemiology

ASJC Scopus subject areas

  • Water Science and Technology
  • Waste Management and Disposal
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases


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