Non-detection of emerging and re-emerging pathogens in wastewater surveillance to confirm absence of transmission risk: a case study of polio in New York

Infectious disease surveillance systems, including wastewater surveillance, can alert communities to the threat of emerging pathogens. We need methods to infer understanding of transmission dynamics from non-detection. We estimate a sensitivity of detection of poliovirus in wastewater to inform the sensitivity of wastewater surveillance for poliovirus using both a clinical epidemiology and fecal shedding approach. We then apply freedom from disease to estimate the sensitivity of the wastewater surveillance network. Estimated sensitivity to detect a single poliovirus infection was low, <11% at most wastewater treatment plants and <3% in most counties. However, the maximum threshold for the number of infections when polio is not detected in wastewater was much lower. Prospective wastewater surveillance can confirm the absence of a polio threat and be escalated in the case of poliovirus detection. These methods can be applied to any emerging or re-emerging pathogen, and improve understanding from wastewater surveillance. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the CDC’s ELC Program, Award Number NU50CK000516. This project was also made possible by the CDC’s Environmental Public Health and Emergency Response Program, Award Number NUE1EH001341. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This is a modeling study using publicly available data - no IRB was required. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes We can include most of the data as a supplemental file. The Zip-code level polio vaccination rates cannot be included due to privacy concerns.