Wastewater surveillance for early pathogen detection in Asia

Wastewater surveillance (WS) has emerged as an important population-based surveillance tool for early pathogen detection to inform timely public health action. Despite global guidance to initiate WS programming in Asia, the priorities and needs in Asia remain poorly understood. To address this gap, we conducted a cross-sectional assessment of WS efforts in Asia. An institutional survey recorded 89 separate projects among 45 institutions in 19 countries in Asia. Financing for WS was equally split between domestic and external resources. Most projects were research-oriented, with one-fifth embedded within national surveillance systems. Influents from urban wastewater treatment plants were the most common sampling sources identified, with either monthly or weekly sampling frequencies. Most efforts were single-pathogen focused, with SARS-CoV-2, antimicrobial resistance (AMR) bacteria, enterovirus, influenza and poliovirus being the top five pathogens assessed. Despite challenges including limited funding and government support, there has been substantial recent progress on the adoption of WS across Asia. Opportunities to enhance sustainability and scale will depend upon efforts to document public health use cases, support national planning and budgeting, develop tailored protocols and regional guidance, and advance innovative multi-pathogen approaches that leverage innovations including pathogen genomics to advance cost-efficient WS systems for public health impact.

废水监测（Wastewater Surveillance, WS）已成为一项重要的基于人群的监测工具，可用于早期检测病原体，为及时开展公共卫生行动提供决策依据。尽管全球已发布在亚洲启动废水监测项目的相关指南，但亚洲地区的监测优先事项与实际需求仍鲜为人知。为填补这一研究空白，我们针对亚洲的废水监测工作开展了一项横断面评估。本次机构调研共记录到亚洲19个国家的45家机构所开展的89项独立项目。废水监测的资金来源由国内与外部资源各占一半。多数项目以研究为导向，其中五分之一的项目嵌入国家监测体系内。城市污水处理厂的进水样本是最常见的采样源，采样频率多为每月或每周一次。多数项目以单一病原体为检测重点，前五大检测病原体依次为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）、抗菌素耐药（Antimicrobial Resistance, AMR）细菌、肠道病毒、流感病毒与脊髓灰质炎病毒。尽管面临资金有限、政府支持不足等挑战，但近期亚洲地区的废水监测应用已取得显著进展。提升其可持续性与规模化水平的机遇，将取决于多项工作：梳理公共卫生应用场景、支持国家规划与预算编制、制定定制化操作方案与区域指南，以及推进创新性多病原体研究路径——包括依托病原体基因组学等技术创新，打造兼具成本效益的废水监测系统，以实现公共卫生效益。