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Collaboration in Action: One Health and Wastewater Surveillance. ASTHO connected with several states to discuss how they are approaching the One Health approach to wastewater surveillance. These conversations highlight the role of coordination and communication across sectors—from environmental and public health to community partners—and the impact that collaboration has had on strengthening their efforts. 2025.
QUESTION:
Tell us about the wastewater surveillance program in your jurisdiction and what pathogens your jurisdictions survey using wastewater?
JOLI WEISS:
In Arizona, we participate in CDC's National Wastewater Surveillance Program, and we have 25 sites in Arizona in eight different counties. So, we cover about 50% of our population.
JAMIE MIDDLETON:
Currently, Los Angeles County was also awarded funding to start their own wastewater surveillance program. We will be utilizing metagenomic sequencing, which will allow us to test all of the genetic material within the wastewater. So one test will be able to identify many different pathogens at the same time at a single cost.
QUESTION:
What partners are engaged in wastewater surveillance efforts, and how is messaging handled?
WEISS:
We work closely with other epidemiology programs, in particular our respiratory disease program and our vector zoonotic disease program, our local county public health partners, as well as environmental health partners, city officials, Department of Agriculture, and Department of Game and Fish.
CHANTELLE BATTON:
So we work closely with our local health authority partners. We send them wastewater surveillance data weekly and also do program updates monthly with our local health authority partners and our laboratories.
HANNA OLTEAN:
We have a community-facing dashboard that shares information with the public regarding epidemiology findings and wastewater. We also have an internal-facing dashboard that's important for public health partners so local health jurisdictions can compare wastewater-based epidemiology findings with other surveillance parameters.
QUESTION:
How does your jurisdiction implement a One Health approach to wastewater surveillance and what are the benefits and challenges of using the One Health approach?
BATTON:
Through One Health, we've been able to establish great partnerships that we wouldn't have been able to before, and we were able to create a One Health team. With that team, we've worked with the Nevada Department of Agriculture, Nevada Department of Wildlife, universities, 4-H extensions to really build that framework.
WEISS:
It's been really beneficial to have all those partners help us make decisions about how to interpret results and determine what targets we want to look at to bring on board.
In particular, for H5, it was very helpful to speak with our Game and Fish partners to look at migratory bird patterns. So when we got our first positive in our wastewater, we asked: was that also correlating with our migratory bird patterns?
OLTEAN:
To date, we do not have sampling for a zoonotic pathogen in our wastewater. However, in anticipation of bringing on influenza A H5 subtyping, we have been doing quite a bit of planning from a One Health perspective. This will include a presentation at our One Health collaborative meeting, which engages Departments of Agriculture, Departments of Fish and Wildlife, and different environmental public health groups to make sure that everyone is aware and understands the types of data collection that's happening, as well as results and interpretation—how those results will be messaged and the ways that we'll need to collaborate in both planning and response efforts.
MIDDLETON:
Some of the challenges with wastewater scanning are that it's so new that it is difficult to understand baselines. One of the things that may help us with that is our metagenomic analysis, which will help us to understand a lot of pathogens—especially zoonotic pathogens—that may go misdiagnosed or underdiagnosed, and to start creating some of those baselines.
QUESTION:
Are there any One Health success stories you'd like to highlight?
BATTON:
We detected H5 in the wastewater before we even had any dairy herd illnesses, before we had any human detections. We were able to work with our Department of Agriculture and Department of Wildlife to pinpoint where those detections were coming from. We were able to actually pinpoint exactly what dairy that was coming from. And so with that One Health approach, we were able to minimize the dairy impacts but also the human health impacts together.
MIDDLETON:
On October 28, 2024, we had a wastewater detection for an area that services about 4.8 million people. What was interesting about this positivity is that it was higher than any of the other wastewater sites since the inception of the program in May 2024.
DE ST MAURICE:
For our human component, we first looked at our emergency department data to see if our syndromic surveillance unit was picking up additional detections. We also looked at our electronic lab reporting data for influenza, and we saw that in areas serviced by that sewershed, we didn't see any increases in influenza A positivity, suggesting that this wasn't driven by humans.
MIDDLETON:
We do have a closed wastewater system, so we realized that this detection was not likely due to migratory birds or wild birds. There were no dairies or poultry industry local to those areas, but there were a lot of processing plants. We had mapped out all of the dairy and poultry processing sites. This data was really helpful for looking at this sewershed and finding that there were 16 different processing facilities that processed within the sewershed. We roughly estimate about 800,000 gallons of milk product is brought in on a daily basis.
We didn't have positivity in any of the dairy herds in Los Angeles County during that time. Where we do import from in the Central Valley had about 500 infected dairies at that time. So that would help explain the sudden very high increase in H5 detection in wastewater.
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