Chinese Urban Wastewater Surveillance System for Early Warning of Infectious Diseases: Implementation and Efficacy - January 2023-June 2025.

Wastewater surveillance has emerged as a powerful tool for public health monitoring, particularly during disease outbreaks. This report documents China's pioneering establishment of the first nationwide comprehensive wastewater surveillance system with multi-scenario applications during the coronavirus disease 2019 (COVID-19) pandemic (January 2023-June 2025). The system integrated three components: national urban wastewater surveillance, inbound international aircraft wastewater surveillance, and pilot public health risk surveillance. This integrated framework demonstrated significant effectiveness in providing early warnings for COVID-19, polio, monkeypox, and other infectious disease outbreaks, while advancing variant tracking capabilities. These findings underscore the critical role of wastewater surveillance in augmenting existing public health infrastructure and improving outbreak detection capabilities. Implementing standardized protocols and developing collaborative networks will strengthen pandemic preparedness and enhance global public health resilience.