Wastewater-based epidemiology in India: current status, prospects, and recommendations

Abstract

WBE workflow. The dual burden of communicable and non-communicable diseases in India is putting a significant strain on the country's healthcare system. Conventional public health assessment tools alone cannot tackle multifaceted public health crises in India. There is a need for novel tools to monitor public health in near real-time, complementing existing health assessments. Wastewater-based epidemiology (WBE) is a technique that can provide essential information on the population's health and behavior within a given catchment boundary in near real-time by detecting urinary and fecal markers in municipal wastewater. Triggered by the COVID-19 pandemic, WBE attracted the attention of the scientific community in India to monitor the progression of COVID-19 disease in the population. WBE studies in India have mainly focused on monitoring infectious diseases and antimicrobial resistance. The existing network of sanitation infrastructure across India indicates a promising future for WBE in the country. This systematic review summarizes the work done so far in the field of WBE in India, discusses the challenges, and emphasizes the need to expand its horizon to unlock its full potential in the rapid identification of emerging health threats that contribute to the public health burden. A roadmap has been proposed for the nationwide implementation of WBE.