ECDC framework to guide the integration of wastewater-based surveillance into infectious disease surveillance at the EU/EEA level
This ECDC framework serves to guide the integration of wastewater-based surveillance (WBS) into infectious disease surveillance and public health decision-making at the EU/EEA level. It outlines how ECDC will strategically and scientifically lead this integration and provides contextual information for policymakers at the national level and in EU institutions, public health stakeholders at the national level, and country actors in the relevant sectors. Key European initiatives promoting WBS and the role of WBS in infectious disease surveillance are also described, including important considerations and challenges.
Summary
WBS can provide useful data for monitoring polioviruses, SARS-CoV-2, influenza viruses and other pathogens. It can also offer informative infectious disease surveillance data for risk assessments and public health decision-making, and can complement data from other established indicator- and event-based surveillance. WBS data should be interpreted and communicated in relation to data collected by these other surveillance systems. WBS systems for public health need careful planning and should address public health needs.
Changes in EU legislation in early 2025 have made wastewater sampling for multiple purposes mandatory in EU Member States. The recast Urban Wastewater Treatment Directive requires Member States to establish enhanced stakeholder collaboration, identify pathogens for WBS, perform WBS routinely and in public health emergencies, and report WBS data to the European Commission. The Directive also introduces a requirement to conduct monitoring of antimicrobial resistance in wastewater.
Effective integration of WBS into infectious disease surveillance requires automated real-time access to electronic WBS data. At present, WBS data collection and integration at the EU/EEA level is insufficient; as the new Directive includes data reporting obligations, this will require continued investments at national and EU/EEA levels. Ensuring the sustainability of human resource and operational investments done thus far – at both EU and national levels – is paramount to build solid structures now and in the years to come.
To coordinate the consolidation and further integration of WBS as a complementary surveillance system for infectious disease at the EU/EEA level, ECDC will:
- Action 1 – Form a WBS network within ECDC’s Coordinating Competent Bodies structure to support the development of a sustainable and flexible EU/EEA-level WBS system.
- Action 2 – Offer laboratory support activities for the WBS network.
- Action 3 – Identify candidate pathogens and related health issues for routine WBS for infectious disease through a combination of stakeholder consultation and ECDC expert assessment.
- Action 4 – Coordinate and support the integration of WBS data into infectious disease surveillance, considering key challenges (see Annex) and potential needs for new surveillance standards.
- Action 5 – Identify the most suitable database and reporting options for EU/EEA-level WBS data; in particular, EpiPulse will be explored for WBS data collection and integration.
