Wastewater-based epidemiology for preventing outbreaks and epidemics in Latin America - Lessons from the past and a look to the future

Wastewater-based epidemiology (WBE) is an approach with the potential to complement clinical surveillance systems. Using WBE, it is possible to carry out an early warning of a possible outbreak, monitor spatial and temporal trends of infectious diseases, produce real-time results and generate representative epidemiological information in a territory, especially in areas of social vulnerability. Despite the historical uses of this approach, particularly in the Global Polio Eradication Initiative, and for other pathogens, it was during the COVID-19 pandemic that occurred an exponen-tial increase in environmental surveillance programs for SARS-CoV-2 in wastewater, with many experiences and devel-opments in the field of public health using data for decision making and prioritizing actions to control the pandemic. In Latin America, WBE was applied in heterogeneous contexts and with emphasis on populations that present many socio-environmental inequalities, a condition shared by all Latin American countries. This manuscript addresses the concepts and applications of WBE in public health actions, as well as different experiences in Latin American countries, and discusses a model to implement this surveillance system at the local or national level. We emphasize the need to implement this sentinel surveillance system in countries that want to detect the early entry and spread of new patho-gens and monitor outbreaks or epidemics of infectious agents in their territories as a complement of public health surveillance systems.

Automated summary

Wastewater-based epidemiology (WBE) is a method that can complement clinical surveillance systems. It provides early warning of possible outbreaks, monitors spatial and temporal trends of infectious diseases, and generates real-time results and representative epidemiological information, especially in areas of social vulnerability. This manuscript discusses the concepts and applications of WBE in public health actions, as well as experiences in Latin American countries, and proposes a model for implementing this surveillance system at the local or national level. It emphasizes the need to implement WBE as a complement to public health surveillance systems in countries that want to detect the early entry and spread of new pathogens and monitor outbreaks or epidemics of infectious agents in their territories.