Sampling Schemes in Poliovirus Wastewater Surveillance Studies from European Countries and Their Comparison to Other Studies: A Literature Review 
Jan Rožanec, Veronika Učakar, Andrej Steyer, Rosa M. Pintó Solé and An Galičič

DOI: 10.3390/microorganisms14040861 (registering DOI)

Abstract:

Poliovirus wastewater surveillance (WWS) is an important complementary system to acute flaccid paralysis surveillance and a substitute surveillance for enteroviruses in stool samples of children, within global poliovirus eradication efforts. However, current guidelines provide limited data on sampling schemes for polio-free countries. This study aims to provide a summary of sampling schemes used for poliovirus WWS in studies done in countries of European Union (EU), together with an analysis of their objectives and a comparison with studies done in other countries. The study selection for this literature review was based on three sources: a World Health Organisation literature review, the PubMed database, and a systematic literature review of WWS of communicable disease agents. From 1446 studies, 72 studies published between 1 January 1995 and 5 September 2024 were included in the qualitative analysis. These studies were analysed by country of origin, objective, sampling site, catchment population size, sampling frequency, sampling method and sample volume. The results indicate that most studies from EU countries had conducted poliovirus WWS directly in line with World Health Organisation recommendations, despite these being primarily designed for developing countries. Our review may encourage countries to optimise their poliovirus WWS systems based on their own risks for poliovirus introduction and circulation.

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Public health responses following identification of poliovirus in wastewater
Marie Lesenfants, Elisabetta Suffredini, Pamela Mancini, Agata Franco, Daniele Congiu, Jan Richter, Christina Christodoulou, Anke Meyers, Shahin Huseynov, Paola Stefanelli and Giuseppina La Rosa

DOI: 10.1016/S2468-2667(26)00051-4

Abstract:

Poliovirus continues to pose a global public health threat, with both wild and vaccine-derived viruses detected in clinical and environmental samples, including in countries declared to be polio free. Although wastewater and environmental surveillance increasingly reveal silent poliovirus circulation, how these findings are translated into public health action remains unclear. We reviewed the literature to identify documented events in which poliovirus detection in wastewater triggered public health responses across WHO regions. 26 unique events across 21 countries and all six WHO regions were included. Public health actions were analysed across five response domains defined for this Review: environmental surveillance; clinical surveillance; vaccination; risk communication; and coordination. Across diverse epidemiological contexts, poliovirus detection in wastewater consistently prompted public health action, often in the absence of paralytic cases. Enhanced environmental surveillance was the most common response, frequently accompanied by intensified clinical surveillance and targeted vaccination activities. Overall, our Review highlights environmental surveillance as an operational early warning system within the Global Polio Eradication Initiative and provide insights applicable to preparedness and response frameworks beyond poliovirus.

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Predicted no effect concentrations of antifungals for wastewater management and agricultural use
Gil D, José S, Ascenso A, Babič MN, Segal E, Meletiadis J, Gangneux JP, Weiskerger CJ, Solo-Gabriele HM, Valério E and Brandão J

DOI: 10.3389/ftox.2026.1767925

Abstract:

Antifungal resistance is an on-growing public health concern due to the difficulty in managing or treating medical conditions that often favour fatal fungal infections. The changing climate and globalisation, which increase fungal persistence and propagation, adds to that concern. Wastewater disposal is one potential source to the environment as antifungals are released into it. Considering that most fungal infections originate from the environment and considering the One Health principle, introducing antifungals through wastewater effluents has the potential to promote the emergence and dissemination of antifungal resistance. The objective of this study was to generate knowledge that can assist regulating the release of antifungals in the environment by quantifying predicted no-effect concentrations (PNECs) that would not promote antifungal resistance. For this purpose, a systematic review was performed to consolidate information on antifungals released to the environment and respective concentrations. The systematic literature review followed Preferred Reporting Items for Systematic literature reviews and Meta Analyses extension for Scoping Reviews (PRISMA-SLR). The analysis of 122 reviewed articles using this approach showed high concentrations and dispersion of antifungals in water, wastewater or soil. This highlights their potential dispersion in the environment, thus increasing the potential of fungal antimicrobial resistance. Due to the lack of PNEC values using fungi as model organisms in this review, PNECs for 17 antifungals were calculated using Candida albicans as model, as it is done for clinical purposes. We consider that the antifungal PNECs calculated and consolidated from the literature can be used to prioritise them for regulation and to determine acceptable levels in wastewater effluents.

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Towards the institutionalization of wastewater surveillance for public health: results from the EU-WISH mapping survey
Jose Antonio Baz-Lomba, Jori Perälä, Tarja Pitkänen and Tuija Leino

DOI: 10.1093/eurpub/ckaf259

Abstract:

Wastewater-based surveillance (WBS) is increasingly recognized as a valuable tool for monitoring public health at the population level. However, its integration into national public health frameworks across Europe remains uneven. In mid-2024, the EU-WISH Joint Action conducted a system mapping survey across 27 European countries to assess the governance, development, and integration of WBS systems. The survey combined quantitative and qualitative data to evaluate national strategies, legal and financial frameworks, and system capacities. By May 2024, most participating countries had operational WBS systems, primarily targeting SARS-CoV-2. Other monitored targets included influenza and other respiratory viruses, poliovirus, antimicrobial resistance (AMR), emerging pathogens, illicit drugs, and health-related biomarkers. Prioritization in system design was largely based on operational feasibility and perceived public health value. Challenges identified included fragmented governance, lack of sustainable financing, and limited workforce capacity. Integration into public health decision-making varied, and dissemination practices differed significantly across countries and surveillance targets. The EU-WISH survey provides a baseline assessment of WBS implementation across Europe and highlights key enablers and barriers to its institutionalization. The findings support ongoing efforts at national and EU levels to enhance coordination, sustainability, and integration of WBS into routine public health frameworks.

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Integrating AMR surveillance into wastewater monitoring systems in 2025: a position on the implementation of Article 17 of the Urban Wastewater Treatment Directive (UWWTD)
Louise Hock, Roosmarijn Luiken, Elisabete Valério, Marta Vargha, Julia Vierheilig, Stefan Börjesson, Tarja Pitkänen and Heike Schmitt

DOI: 10.2807/1560-7917.ES.2026.31.3.2500289

Abstract:

The recast Urban Wastewater Treatment Directive (UWWTD) calls for monitoring antimicrobial resistance (AMR) in wastewater of large European agglomerations (≥ 100,000 person equivalents). Guidance on scope and methods is currently in development. Two European Joint Actions share a goal to harmonise procedures and indicators: the European Union (EU)-Wastewater Integrated Surveillance for Public Health (EU-WISH), aiming to strengthen wastewater-based surveillance (WBS) for public health and the EU-Joint Action Antimicrobial Resistance and Healthcare Associated Infections (EU-JAMRAI) 2, providing among others, approaches for environmental surveillance of AMR. An EU-WISH survey in 2024, mapping WBS AMR-related activities across Europe, revealed that of 27 countries surveyed, 11 had an operative AMR WBS system and mainly employed WBS to determine AMR trends, primarily through culture-based analyses, in-depth characterisation of specific bacteria, and quantitative PCR for specific resistance genes. Occasionally metagenomics was used. We argue that prioritising AMR WBS targets should consider the intended objectives of surveillance, which could include uncovering AMR trends and emerging AMR determinants in humans, the assessment of antimicrobial/AMR environmental release, and wastewater treatment efficiency. Targets should be assessed for their public health relevance and the usefulness of complementary information they provide, while integrating measurability, resource efficiency, and expertise from different One Health domains.

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