ArticlemedRxiv : the preprint server for health sciences2025
Environmental pathogen surveillance in cities without universal conventional wastewater infrastructure.
Article in medRxiv : the preprint server for health sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Although wastewater surveillance for assessing community health and well-being is now mainstream, most cities in low- and middle-income countries lack conventional wastewater services. In these settings, environmental surveillance beyond conventional wastewater offers the potential to inform public health responses, design interventions intended to reduce exposures, and to evaluate infection control programs. To explore these potential use cases, we measured pathogens, source-tracking markers, and fecal indicator bacteria in wastewater treatment plant (WWTP) influent and effluent, wastewater surface discharges, impacted river water, impacted soils, open drains, stormwater, and fecal sludges from onsite sanitation in Maputo, Mozambique. We detected a wide range of pathogens by multi-parallel RT-qPCR across all matrices, revealing a nuanced picture of pathogen flows in the city and suggesting the potential for exposures beyond those typically included in studies of sanitation and health. We developed a pooled regression model and observed lower pathogen concentrations in direct wastewater discharges (mean difference -1.4 log
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