Abstract
Infectious diseases are acknowledged as one of the most critical threats to global public health today. Climate change, unprecedented population growth with accelerated rates of antimicrobial resistance, have resulted in both the emergence of novel pathogenic organisms and the re-emergence of infections that were once controlled. The consequences have led to an increased vulnerability to infectious diseases globally. The ability to rapidly monitor the spread of diseases is key for prevention, intervention and control, however several limitations exist for current surveillance systems and the capacity to cope with the rapid population growth and environmental changes. Wastewater-Based Epidemiology (WBE) is a new epidemiology tool that has potential to act as a complementary approach for current infectious disease surveillance systems and an early warning system for disease outbreaks. WBE postulates that through the analysis of population pooled wastewater, infectious disease and resistance spread, the emergence of new disease outbreak to the community level can be monitored comprehensively and in real-time. This manuscript provides critical overview of current infectious disease surveillance status, as well as it introduces WBE and its recent advancements. It also provides recommendations for further development required for WBE application as an effective tool for infectious disease surveillance.
Highlights
Even with the advancement of infectious disease surveillance over the last century, communicable diseases still pose significant risks to public health
Emerging infectious diseases caused by novel pathogenic organisms are of notable concern, it was highlighted by World Health Organisations (WHO) that since the 1970s, over 1500 new pathogens were discovered and nearly 40 new infectious diseases have been identified (World Health Organisation, 2018a)
The results from clinics are often from a very small proportion of the population who are ill and not representative of the population as a whole, as many people can be carriers of a disease or a resistance gene and not experience symptoms. It was highlighted by WHO’s Global Antimicrobial Resistance Surveillance System (GLASS) programme that a limitation is that current samples are focused on a clinical level and more epidemiological information on a population scale are needed for antimicrobial resistance (AMR) surveillance purposes (World Health Organisation, 2018b)
Summary
Even with the advancement of infectious disease surveillance over the last century, communicable diseases still pose significant risks to public health. Emerging infectious diseases caused by novel pathogenic organisms are of notable concern, it was highlighted by WHO that since the 1970s, over 1500 new pathogens were discovered and nearly 40 new infectious diseases have been identified (World Health Organisation, 2018a) Many of these have severely impacted communities, with several major outbreaks occurring within the last 20 years including severe acute respiratory syndrome (SARS) (2002–2003), Ebola (2014–2016), H1N1flu (swine flu) (2009–2010), Zika virus (2015–2016) and COVID-19 (2019–2020) (World Health Organisation, 2020a). Two others on this list are regarding the prevention and treatment of infectious disease, one being hesitation to vaccinate and the other the rise in antimicrobial resistance (AMR), both have been linked to the re-emergence of communicable diseases. Candida auris, an emerging multidrug resistant yeast, is a cause of major hospital acquired infection with high associated mortality, having only first been identified in 2009 it has resistance to all
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