从污水到监测：通过尼泊尔和菲律宾的废水流行病学推进健康监测（英）

Advancing Health Monitoring Through Wastewater-BasedEpidemiology in Nepal and the Philippines ACKNOWLEDGMENTS This brochure was produced by the Water and Urban Development Sector Office, Sectors Department 2 ofthe Asian Development Bank (ADB), with the support of the Government of Austria, through the technicalassistance, Accelerating Sanitation for All in Asia and the Pacific. Jitendra Singh, ADB water supply andsanitation specialist, led its development. Allison Woodruff, ADB principal water security specialist; andAmandeep Singh, ADB senior social sector specialist, provided invaluable inputs and reviews. GrazielSalazar, ADB consultant; Sarah Durry; Stephen Hilton; Pengbo Liu; Christine Moe; and Suraja Raj of theCenter for Global Safe Water, Sanitation, and Hygiene at Emory University, provided significant technicalinputs in preparing this brochure. In addition, Elga Reyes, ADB consultant, supported with writing andediting; Gino Pascua, ADB consultant, handled layout and design; and Marie Christelle Garcia and AnalynF. Rubenecia, ADB consultants, coordinated and oversaw the production. The views expressed in this publication are those of the authorsand do not necessarily reflect the views and policies of theAsian Development Bank (ADB) or its Board of Governors orthe governments they represent. ADB does not guarantee theaccuracy of the data included in this publication and accepts noresponsibility for any consequence of their use. By making anydesignation of or reference to a particular territory or geographicarea in this document, ADB does not intend to make anyjudgments as to the legal or other status of any territory or area. © 2025 ADB. The CC license does not apply to non-ADB copyright materials in this publication. http://www.adb.org/publications/corrigendapubsmarketing@adb.org https://www.adb.org/terms-use#openaccessPublication Stock No. ARM250560-2DOI: http://dx.doi.org/10.22617/ARM250560-2 FROM SEWAGETO SURVEILLANCE Advancing Health Monitoring Through Wastewater-BasedEpidemiology in Nepal and the Philippines Revolutionizing Health Surveillance:The Power of Wastewater-Based Epidemiology Innovative solutions are crucial for monitoring and combating the spread of infectious diseases amid global health crises. The spread ofthe severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, which causes the coronavirus disease (COVID-19), highlightedthe limitations of conventional disease surveillance methods, specifically limited diagnostic testing and delays in reporting. Wastewater-based epidemiology (WBE) has emerged as a powerful tool for acquiring data and insights into community infection levels by measuringthe presence and magnitude of specific pathogen genetic markers in human excreta. This noninvasive method enables early detectionof new infections and changes in infection rates, which often precede clinical case surges. Beyond improving the tracking of SARS-CoV-2, WBE lays the groundwork for versatile disease surveillance. This technology can helpmonitor the prevalence of other pathogens, optimize resources, and enhance alignment with global health initiatives. By analyzingwastewater samples from multiple points before treatment, this approach increases the understanding of pathogen transmission andsupports targeted public health interventions. Wastewater-based epidemiologyis also referred to as wastewater surveillance, wastewater monitoring, and environmental surveillance.It is a method that systematically collects and analyzes wastewater influent samples for pathogen nucleic acids. The data obtainedprovides a comprehensive view of infection prevalence, offering a more inclusive foundation for informed public health decisions. How Is WBEDifferent fromRoutine DiseaseSurveillance? According to the World Health Organization (WHO), “public healthsurveillance is the continuous, systematic collection, analysis, and interpretationof health-related data,” adding that disease surveillance data acts as an earlywarning system for emerging outbreaks and enables monitoring and evaluationof an intervention. It can also examine the epidemiology of health issues to helpguide public health priorities and strategies.1 WBE, on the other hand, is a population-level surveillance tool; essentially,a part of the wider routine or multimodal public health surveillance. As such,it can also inform about subpopulations who are asymptomatic or unable toaccess health services, as opposed to routine surveillance that depends onpopulations accessing health services. Furthermore, by tracking pathogensand viruses in sewage, it can offer a closer look into a community’s health andlifestyle habits.2 The WBE developed for SARS-CoV-2 can be leveraged to expand to a widerrange of pathogens such asVibrio cholerae, Salmonella typhi, and Orthoflavivirusdenguei(dengue virus). Each wastewater or fecal sludge sample can be testedfor multiple pathogens simultaneously using multiplex polymerase chainreaction (PCR) prot