review · International Journal of Infectious Diseases
A systematic review and meta-analysis examined global evidence on wastewater-based epidemiology (WBE) for public health surveillance, covering studies from 2000 to 2025. The analysis of 39 studies revealed a geographical skew, with most research originating from Europe (48.7%) and the Americas (23.1%), and significant underrepresentation in low- and middle-income countries. Viruses were the primary targets (89.7%), followed by bacteria (7.7%) and parasites (2.6%). A pooled pathogen detection prevalence of 62% was found, with the European Region showing the highest estimate (73%) and the African Region the lowest (8.3%). Conventional PCR and sequencing methods demonstrated higher detection rates than RT-qPCR. The findings indicate WBE is a robust early-warning system, but requires broader pathogen diversity and expansion into rural and resource-limited regions.
This research highlights the current state and limitations of wastewater-based epidemiology, a vital tool for public health. By identifying geographical and pathogen-type gaps, it informs strategies to improve global disease surveillance, particularly in underserved regions, enabling earlier detection and response to outbreaks.
This work supports the ongoing development and deployment of wastewater surveillance systems for public health. It could inform organisations involved in environmental monitoring and disease control, helping them refine methods and expand programmes to detect a wider range of pathogens, including bacteria and parasites. This is applied research, identifying needs for further implementation and method refinement to enhance early-warning capabilities.
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Background Wastewater-based epidemiology (WBE) has emerged as a critical tool for public health surveillance, yet its application across diverse pathogens and geographical settings remains inconsistent. This systematic review synthesizes global evidence on wastewater surveillance to identify associated risk factors. Methods Following PRISMA 2020 guidelines (PROSPERO: CRD420261297382), a systematic search was conducted across PubMed, Scopus, Google Scholar, and Web of Science for studies published between 2000 and 2025. Results Thirty-nine peer-reviewed studies were included. The evidence base is geographically skewed toward the European Region (48.7%) and the Americas (23.1%), with significant underrepresentation in LMICs. Viruses were the primary biological target (89.7%), followed by bacteria (7.7%) and parasites (2.6%). A proportion meta-analysis of 31 eligible studies demonstrated a pooled wastewater pathogen detection prevalence of 62% (95% CI: 47.5-74.6%), with the European Region yielding the highest regional estimate (73%) and the African Region the lowest (8.3%). Conventional PCR and sequencing methods showed higher pooled detection rates (92.4% and 90.1%, respectively) than RT-qPCR (47.9%). Conclusion WBE provides a robust early-warning system indicating a need for broader pathogen diversity, incorporating bacterial and parasitic surveillance and expansion into rural and resource-limited regions.
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DOI: 10.1016/j.ijid.2026.109097
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