monitoring enteroviruses, namely poliovirus, was instituted as early as 1996 in Russia. Wastewater testing is recognised as an important tool for poliovirus surveillance by the WHO, especially in situations where mainstream surveillance methods are lacking, or where viral circulation or introduction is suspected. Wastewater-based epidemiology of viruses has the potential to inform on the presence of viral outbreaks when or where it is not suspected. A 2013 study of archived wastewater samples from the Netherlands found viral RNA of Aichivirus A in Dutch sewage samples dating back to 1987, two years prior to the first identification of Aichivirus A in Japan. During the COVID-19 pandemic, wastewater-based epidemiology using qPCR and/or RNA-Seq was used in various countries as a complementary method for assessing the load of COVID-19 and its variants in populations. Regular surveillance programs for monitoring SARS-Cov-2 in wastewater has been instituted in populations within countries such as Canada, UAE, China, the Netherlands, Singapore, Spain, Austria and the United States. Applications against major outbreaks Wastewater surveillance, which substantially expanded during the earlier COVID-19 pandemic was used to detect monkeypox in the 2022 monkeypox outbreak. It is unclear how cost-effective wastewater surveillance is but national coordination and standardized methods could be useful. Less common infections may be difficult to detect, including such as those that cause hepatitis or foodborne illness. A warning of increased cases from wastewater surveillance can "provide health departments with critical lead time for making decisions about resource allocation and preventive measures" and "unlike testing of individual people, wastewater testing provides insights into the entire population within a catchment area". A 2023 report by the National Academies of Sciences, Engineering and Medicine called for moving from the grass roots system that "sprung up in an ad hoc way, fueled by volunteerism and emergency pandemic-related funding" to a more standardized national system and suggested such a system "should be able to track a variety of potential threats, which could include future coronavirus variants, flu viruses, antibiotic resistant bacteria and entirely new pathogens". Antimicrobial resistance In 2022, genomic epidemiologists reported results from a global survey of antimicrobial resistance (AMR) via genomic wastewater-based epidemiology, finding large regional variations, providing maps, and suggesting resistance genes are also passed on between microbial species that are not closely related. See also Drug test Forensic toxicology Urinalysis Wastewater surveillance References Epidemiology Public health Water management