Wastewater Surveillance for Early Warning of Infectious Disease Outbreaks: A Systematic Review of Evidence and Implications for One Health Surveillance

Introduction: Integrated One Health-based surveillance of pathogens in wastewater suggests its potential for monitoring community health and preventing the emergence and spread of infectious diseases. Despite the growing popularity of Wastewater Surveillance (WWS) and its clinical utility, its uniformity remains poorly understood, especially concerning its clinical evidence. This review systematically synthesizes evidence on the role of wastewater surveillance in early pathogen detection and outbreak preparedness, with particular emphasis on its implications for One Health surveillance. Methods: We systematically searched PubMed, EMBASE, ProQuest and EBSCO CINAHL databases. Retrieved articles were screened by two reviewers, and conflicts were resolved by a third reviewer. Initially, 539 studies were retrieved as potentially eligible published articles, of which 16 articles fulfilled the inclusion criteria. Results: Most pathogens identified in the included studies were associated with respiratory and gastrointestinal infections. Studies found a positive link between the presence of pathogens in wastewater and clinical cases, depicting potential exposure and transmission within the communities. A season-specific upsurge was observed among the identified pathogens in circulation. In addition, the duration and frequency of sample collection in socio-vulnerable areas provide early warning of disease outbreaks. Few studies have explicitly operationalized a One Health framework, highlighting the need for integrated human, animal, and environmental surveillance systems in future wastewater surveillance programmes. Conclusion: The review emphasized wastewater surveillance as a promising complementary approach for the early detection and tracking of pathogens. Future research is needed to standardize surveillance approaches and strengthen One Health integration across human, animal and environmental health systems.