Pandemic monitoring with global aircraft-based wastewater surveillance networks.

Summary

Modeling shows that 10–20 strategically placed airport wastewater sentinel sites can serve as an effective early warning system for respiratory pandemics, with diminishing returns beyond a critical number. The framework identifies blind spots and optimization strategies, and retrospective analyses indicate markedly shortened detection times.

Key Findings

• Networks with 10–20 sentinel airports provided timely situational awareness and effective early warning for respiratory pathogens.
• Beyond a critical number of sites, additional sentinels yielded diminishing returns, emphasizing resource optimization.
• Retrospective analyses showed aircraft wastewater networks can shorten detection time for emerging pathogens.

Clinical Implications

Public health systems can deploy small, optimized airport WWSNs to gain early signals of variant introduction and spread, informing clinical testing, hospital preparedness, and targeted interventions.

Limitations

• Model-based inferences depend on assumptions about travel patterns and shedding dynamics
• Real-world prospective implementation and cost-effectiveness analyses remain to be demonstrated

Future Directions

Prospective pilot deployments at selected airports, integration with clinical and syndromic surveillance, and evaluation of cost-effectiveness and equity.