Abstract Untreated sewage discharges leading to environmental contamination are increasingly common in communities across the globe. The cause of these discharges range from sewer lines in disrepair, blockages, and in the era of more extreme wet weather events, the infiltration of stormwater into the system during heavy downpours. Regardless of the driver of these events, the aftermath results in raw sewage spilling into local waterways, city streets, and commercial and residential structures. Historical research in public health has thoroughly documented the connection between exposure to untreated sewage and waterborne disease. Recent research has detected antibiotic-resistant bacteria at wastewater treatment facilities at a time when deaths by antibiotic-resistant infections are on the rise. However, no research has explored the exposure pathways of antibiotic resistant bacteria during sanitary sewer overflows and household-level sewage backups. In this commentary, we aim to introduce this new frontier of environmental health risks and disasters. To do this we describe the history of modern sanitation and sewer infrastructure with a particular focus on wastewater infrastructure in the U.S. We also explore emerging risks and current methods for identifying antibiotic-resistant bacteria in the environment. We end with future directions for interdisciplinary scholarship at the nexus of urban planning, engineering, and public health by introducing the Water Emergency Team (WET) Project. WET is a community-based multi-method effort to identify environmental risks in the aftermath of household backups through 1) residential surveys, 2) indoor visual inspections, 3) environmental sampling, and 4) laboratory processing and reporting. Our hope is that by introducing this comprehensive approach to environmental risks analysis, other scholars will join us in this effort and ultimately towards addressing this grand challenge of our time.
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