Building National Wastewater Surveillance for Infectious Diseases in the United States

The Centers for Disease Control and Prevention (CDC) established the National Wastewater Surveillance System in 2020 to detect and quantify SARS-CoV-2 RNA in wastewater across the United States. The system subsequently expanded dramatically from independent local efforts into a coordinated national system. Wastewater surveillance is unique because it does not depend on whether individuals have symptoms, access to healthcare, or clinical tests. It can serve as an early warning system and detect small changes in community transmission of infectious diseases. The CDC currently receives data from approximately 1,500 wastewater sampling sites across all 50 states, 7 territories, and some tribal communities. The system relies on partnerships between public health departments, academic researchers, commercial laboratories, and wastewater operators and engineers.