Wastewater-Based Public Health Surveillance for Emerging Infectious Diseases and Antimicrobial Resistance

Abstract

Wastewater based public health surveillance has emerged as a complementary approach for monitoring infectious diseases and antimicrobial resistance (AMR) at the population level. Unlike conventional clinical surveillance, wastewater analysis can provide community wide information without relying on individual testing or healthcare attendance. This review examines the application of wastewater based epidemiology for monitoring antimicrobial resistance. Current approaches include culture-based methods, PCR, metagenomic sequencing, and bioinformatic analysis for identifying pathogens. Wastewater surveillance can support early detection of pathogen circulation that may remain underrecognized by clinical surveillance. Recent advances in wastewater genomics and machine learning have further expanded opportunities for pathogen detection. However, differences in sampling strategies, wastewater composition, and interpretation of resistance markers remain important challenges. Detection of antimicrobial resistance genes does not always indicate viable resistant pathogens or clinically relevant resistance. Standardized protocols and ethical governance are therefore required to improve reliability and public health utility. Integrating wastewater surveillance with clinical and genomic data within a One Health framework could strengthen early warning systems and improve preparedness for emerging infectious diseases.