Wastewater monitoring, surveillance and epidemiology: a review of terminology for a common understanding

Response to the COVID-19 (coronavirus disease 2019) pandemic saw an unprecedented uptake in bottom-up efforts to incorporate community wastewater testing to inform public health. While not a new strategy, various specialized scientific advancements were achieved to establish links between wastewater concentrations of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and public health outcomes. Maximizing public health benefit requires collaboration among a broad range of disciplinary experts, each bringing their own historical context to the central goal of protecting human health. One challenge has been a lack of shared terminology. Standardized terminology would provide common ground for this rapidly growing field. Based on the review herein, we recommend categorical usage of the term 'wastewater-based epidemiology' to describe the science of relating microbes, chemicals or other analytes in wastewater to public health. We further recommend the term 'wastewater surveillance' to describe continuous monitoring of health outcomes (either microbes or chemicals) via wastewater. We suggest that 'wastewater tracking' and 'wastewater tracing' be used in more narrow ways, specifically when trying to find the source of a health risk. Finally, we suggest that the phrase 'wastewater monitoring' be abandoned, except in rare circumstances when ensuring wastewater discharge is safe from a public health perspective.