Wastewater-Based Epidemiology for Infectious Diseases: A New Trick for an Old Threat.

Wastewater-based epidemiology (WBE) is an innovative approach to epidemiology that offers unique opportunities for public health surveillance. Its potential had been recognized in various applications over the years, but it was the global scale of the response to the SARS-CoV-2 pandemic that truly brought WBE to the fore. In this perspective paper we explore the untapped potential of WBE as a catalyst for infectious disease surveillance and as a One Health epidemiological tool, and the future horizons and innovative applications of WBE. It is clear that WBE will address a growing number of pathogens of concern to human health, such as avian influenza viruses, mpox, enterovirus D68, Candida auris, and antimicrobial resistance. In addition, it will contribute to epidemic intelligence by monitoring mass gathering events, and by predictive modeling and forecasting in combination with artificial intelligence to mitigate and prevent infectious diseases from reaching the highest level of clinical complexity. We believe that the maximum performance and complete institutional integration into public health of WBE is yet to be realized on a global scale.