Background: The Texas Epidemic Public Health Institute was created by the Texas Legislature in 2021 with the mission of strengthening the capacity and resiliency of Texas communities to respond to infectious disease outbreaks. A key early detection program is the Texas Wastewater Environmental Biomonitoring (TexWEB) network.

Objective: To understand the origin and scope of the Texas Epidemic Public Health Network and, specifically, its wastewater surveillance efforts.

Methods: TexWEB collects wastewater samples weekly in municipalities across Texas to test for the presence of more than 3,000 human and mammalian viruses. It analyzes and reports findings weekly to public health officials and clinicians. Reporting protocols were developed in collaboration with local utilities and public health agencies.

Results: Participating public health officials are able to use wastewater data as an additional surveillance tool to monitor viral pathogens of interest, and researchers are using the data to learn more about virome seasonality and to develop predictive models.

Conclusion: TEPHI and the TexWEB network are contributing to public health preparedness in Texas by enhancing the ability of public health officials to detect early and monitor infectious disease outbreaks both at a statewide and community level.

Background - Wastewater surveillance has emerged as a powerful tool in public health preparedness and response, particularly highlighted by its use in monitoring the spread of viruses such as SARS-CoV-2, influenza, and Mpox. This method enables health officials to assess viral load in communities through the analysis of sewage, providing early warnings of disease presence and prevalence.

Objective – To describe the methods employed within the TexWeb consortium wastewater surveillance, discussing its strategic advantages in public health and addressing its limitations.

Methods - The surveillance process involves the collection of wastewater samples followed by the detection of viral RNA through advanced techniques such as Real-time Quantitative Polymerase Chain Reaction (RT-qPCR) for 12 viruses (targeted) and whole genome sequencing for all known mammalian viruses (untargeted). The integration of bioinformatics allows for the analysis of these complex data sets to inform public health action.

Results - We have demonstrated the efficacy of wastewater surveillance in detecting community-wide viral presence before they are observable through clinical data, and have shown the viral prevalence correlates strongly with case numbers. We have utilized our targeted and untargeted methods for up to two years in 9 cities across Texas.

Conclusion - Wastewater surveillance presents a non-invasive, cost-effective method for monitoring viral prevalence over wide geographic areas. While it cannot replace clinical testing, it significantly enhances public health responsiveness through early detection and continuous monitoring.

Background: Wastewater-based epidemiology has gained substantial popularity, especially during the COVID-19 pandemic. Analyzing data collected over time and across various locations poses significant challenges, particularly for those lacking expertise in statistical and modeling techniques.

Objective(s): To review and analyze data from wastewater-based epidemiology to identify temporal trends, make predictions, and assess variability sources.

Methods: We examined data collected from wastewater-based epidemiology on SARs-CoV-2, employing exploratory data visualizations to discern sources of variability. Statistical modeling was applied to analyze temporal trends and make predictions. The focus was on the application of complex models that can integrate data across different geographical locations to enhance predictive accuracy.

Results: Model performance evaluation indicated that capturing the temporal trends in wastewater data depends on data availability and collection duration. Predictive accuracy requires evaluation against actual observations, which can be computationally demanding. Additionally, more complex models demonstrated superior capability in capturing geographical and temporal variations, potentially improving predictive power. However, these models necessitate specialized software and advanced statistical knowledge.

Conclusion: Wastewater epidemiology presents novel opportunities for community-based epidemiological insights but requires advanced statistical expertise to leverage fully. This field's future depends on developing accessible analytical tools that can simplify complex data interpretations for broader usability.

Background: Wastewater testing for infectious agents, opioids, antimicrobial resistance and other public health concerns is undergoing a renewed interest. Data obtained can be very useful for public health surveillance use but limitations, legal and ethical considerations, and community involvement must be considered.

Objective(s): This presentation will discuss how wastewater surveillance data can complement other public health surveillance methods. It will also cover other considerations that must be well-thought-out when releasing data to the public, particularly with sensitive data such as HIV, other STIs, and opioid substances.

Methods: Extant data on potential uses of wastewater surveillance data were reviewed. Likewise, previous publications on the legal and ethical use of these data as well as best practices for community involvement were reviewed and summarized.

Results: Wastewater surveillance data can be used to identify early trends and prepare resources that may be needed, monitor special populations, and inform prevention activities. However, there can be legal, ethical, and equity issues when releasing results to the public and so careful consideration of public health ethics guidelines is necessary. In addition, community involvement through focus groups and community advisory boards is strongly recommended.

Conclusion: Wastewater surveillance is a useful tool for public health practice and epidemiology, complementing other surveillance methods. However, even more than with some other public health tools, there must be intense scrutiny of legal and ethical issues as well as an understanding of the importance of community involvement.