Regional Wastewater Surveillance Training: A Complementary Lens into Public Health in Asia

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Regional Wastewater Surveillance Training: A Complementary Lens into Public Health in Asia

As the world becomes increasingly interconnected, the need for rapid, reliable ways to monitor public health risks has never been more important.

One such tool gaining traction is wastewater surveillance, which has proven itself invaluable in the early detection of pathogens—from familiar viruses like COVID-19 to emerging threats such as bird flu and Zika.

Wastewater surveillance involves testing sewage for pathogens that may not yet be visible in clinical data. When people are infected with a virus, it can be shed in their waste even before they exhibit symptoms, providing an early warning system that can pre-empt major outbreaks. During the COVID-19 pandemic, this approach was widely used to monitor the virus in communities and predict surges in cases.

"Wastewater surveillance monitors the health of a population and can complement clinical surveillance efforts, providing unbiased data on disease prevalence, independent of infected persons’ access to healthcare facilities and health-seeking behaviour,” said Mr Benjamin Lee, Scientist, Wastewater-Based Epidemiology Branch, Microbiology and Molecular Epidemiology Division, National Environment Agency.

“This approach is particularly valuable in Asia, where densely populated urban centres would require timely and sensitive pathogen detection tools.” added Dr Muhammad Hafiz Ismail, Principal Analyst, Wastewater-based Epidemiology Branch, Microbiology and Molecular Epidemiology Division, National Environment Agency. “Wastewater surveillance therefore complements clinical surveillance and compensates for settings with limited healthcare access by simultaneously tracking emerging pathogens in the community.”

Mr Lee and Dr Hafiz were part of a regional wastewater surveillance workshop held in Singapore in October 2024. The event was a joint initiative by the Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), the Duke-NUS Programme in Emerging Infectious Diseases (EID), the National Environment Agency (NEA), and the Duke-NUS Centre for Outbreak Preparedness (COP).

Participants observe how wastewater surveillance is conducted at a residential site in the heart of Singapore

Under the Asia Pathogen Genomics Initiative (Asia PGI) Academy, the workshop brought together 17 public health experts from 13 countries across the region to address the growing need for regional expertise in this field. It was designed to equip participants with the tools and knowledge needed to implement effective wastewater monitoring systems in their own countries.

“The workshop aimed to encourage knowledge exchange and experience sharing on wastewater concentration techniques, how to perform viral detection in wastewater, and next-generation sequencing techniques and methods for multi-pathogen detection,” said Zhu Feng, Senior Research Fellow from Duke-NUS EID.

Participants visited wastewater sample collection sites and engaged in a variety of RNA extraction and sequencing protocols in the laboratory. The hands-on training, complemented by bioinformatics sessions, enabled participants to understand the theoretical foundations of benchwork experiments.

“It also helped participants connect theory from lab experimentation to data interpretation in bioinformatics using next-generation sequencing (NGS) technologies for multi-pathogen detection in wastewater surveillance,” said Dr Suma Tiruvayipati, senior scientist at BII.

Dr Lea Necitas Apostol from the Phillipines appreciates and has been quick to exploit the strength of wastewater surveillance . In 2014, After the WHO identified the Philippines as being at high risk of polio importation, Dr Apostol spearheaded the establishment of the country’s environmental surveillance network to enhance existing surveillance efforts.

In her capacity as Chief Science Research Specialist designated as the Laboratory Manager of the Department of Virology and the Head of the National Reference Laboratory for Polio and Other Enteroviruses at the Research Institute for Tropical Medicine-Philippines (RITM), she ensures that national polio laboratories are ready to operate safely and reliably, detecting and responding to polio, other enteroviral disease outbreaks, and public health emergencies.

“This workshop has widened my skills regarding new methodologies and advanced tools for wastewater-based epidemiology and research,” she said, citing how she was able to meet with counterparts committed to building and strengthening multidisciplinary epidemic research partnerships anchored in the One Health approach.

Participants on a site visit to the Environmental Health Institute, National Environment Agency

Implementing wastewater surveillance could bolster health security efforts significantly. By identifying pathogens before they cause widespread illness, countries can avoid overwhelming healthcare systems and save lives. In large, urban areas where diseases can spread quickly, the ability to track a virus through sewage could provide the lead time necessary to ramp up vaccinations, deploy resources, and implement public health measures.

This Asia PGI Academy workshop represents a vital step toward building these capabilities across the continent. “In a region as diverse and densely populated as Asia,” said Asst Prof Vincent Pang from the Duke-NUS Centre for Outbreak Preparedness, “this tool has the potential to transform the way we respond to future pandemics and public health emergencies, and protect the health of millions.”

Regional Wastewater Surveillance Training: A Complementary Lens into Public Health in Asia

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