Using waste water for human pathogen surveillance ● Waste water surveillance ○ detect viral, bacterial, protozoan pathogens excreted by infected individual ● Functions As early warning tool ○ asymptomatic ○ non-invasive ● Collaborate with multiple organization ○ public health authorities ○ environmental agencies ○ Laboratories ○ Hospitals ● Data must be interpreted alongside clinical and epidemiological information Chinese Health structure ● County and town level CDC ○ collect and test wastewater samples form local sewage ● Data is given to CIDARS for early warning ● escalate through… ○ Provincial CDC ○ National CDC ● Wastewater can complement NIDRIS ○ Can initiate outbreak investigation ● SMS alerts ○ waste water triggered warning Netherland’s Public Health structure ● Local GP’s hospitals ○ Coordinates with municipal waste water facilities ○ Collects samples ● Wastewater data would be submitted to regional public health service ○ Then centralized in National Institute for Public Health ○ RIVM ● Integrates into OSIRIS ○ reproting ● Integrate into Barometer ○ risk assessment and warning ● Ministery of Health guide outbreak responses ● Centralized model enables rapid coordination Which one is better? ● None is likely better than other ● But Nerherlanes are better ○ Fewer layers of reporting ○ Data directly goes to RIVM ○ Easy to implement nationwide quickly and uniformly ■ Rapid response ● Chinese model is better in large scale coverage ○ Massive network ○ 2800 country level CDC and hospital ○ localized outbreaks ○ Reach better in rural areas Aspect China Netherlands Reporting model Multilayered, decentralized Centralized, Fewer layers Early warning integration CIDARS and NIDRIS Through OSIRIS and Barometer Lab County to national level Streamed through RIVM Speed Slower with administrative layer Fast with less intermediates Potential for wastewater use High High