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Life sciences · Review
International Journal of Infectious Diseases · September 1, 2026
Reinforces what was already believed, rather than introducing something new.
This systematic review and meta-analysis of 39 peer-reviewed studies demonstrates that wastewater-based epidemiology achieves a pooled pathogen detection prevalence of 62% (95% CI: 47.5–74.6%), with marked regional variation and higher detection rates using conventional PCR and sequencing than RT-qPCR. The evidence confirms WBE as a viable early-warning surveillance system but reveals substantial geographic and methodologic heterogeneity that limits current generalizability, particularly in resource-limited settings.
Systematic review and meta-analysis. Global wastewater surveillance studies examining pathogen detection; studies conducted in diverse geographic regions with significant overrepresentation in European Region (48.7%) and Americas (23.1%), and underrepresentation in low- and middle-income countries.. Intervention: Wastewater-based epidemiology (WBE) surveillance using various detection methods (conventional PCR, sequencing, RT-qPCR). Global; 48.7% from European Region, 23.1% from Americas, with significant underrepresentation in African Region and other LMICs.
Pooled wastewater pathogen detection prevalence of 62% (95% CI: 47.5-74.6%) across 31 eligible studies European Region yielded highest regional estimate at 73%; African Region lowest at 8.3% Viruses were primary biological target (89.7% of studies), followed by bacteria (7.7%) and parasites (2.6%)
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Clinicians and public health professionals should recognize wastewater-based epidemiology as a validated early-warning surveillance system for pathogen detection; however, current evidence is geographically limited and heavily weighted toward viral targets in high-income regions. Expansion into bacterial, parasitic, and resource-limited surveillance is needed to establish global applicability.
A rigorous systematic review and meta-analysis of 39 peer-reviewed studies that confirms wastewater-based epidemiology as a viable public health surveillance tool, with pooled prevalence estimates and regional variation, but does not establish a new practice standard or clinical intervention.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and public health professionals should recognize wastewater-based epidemiology as a validated early-warning surveillance system for pathogen detection; however, current evidence is geographically limited and heavily weighted toward viral targets in high-income regions. Expansion into bacterial, parasitic, and resource-limited surveillance is needed to establish global applicability.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
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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