Top 10 Takeaways from H5N1 Wastewater Monitoring Podcast

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In the latest episode of “Transmission Interrupted,” host Lauren Sauer, Associate Professor at the University of Nebraska Medical Center and Director of the Special Pathogens Research Network for NETEC, spoke with Dr. Jana Broadhurst, MD, PhD, DTM&H, an Associate Professor in the UNMC College of Medicine and medical director at the Nebraska Medicine Biocontainment Unit Clinical Laboratory. Together, they explored the current landscape of H5N1 wastewater testing and surveillance. Here are the top takeaways from the episode:

1. H5N1 is a subtype of influenza A virus that has been spreading from wild birds to poultry and mammals for many years, including some cases in people, causing severe disease.

2. In the United States, surveillance for highly pathogenic avian influenza (HPAI) viruses in animals is conducted by multiple agencies, including the Animal and Plant Health Inspection Service (APHIS) and the U.S. Fish and Wildlife Service, and involves testing of wild birds, poultry, and livestock, and environmental testing for HPAI viruses in wastewater.

3. Testing and monitoring people for influenza viruses is more complicated. There are different diagnostic tests for influenza, and we use them differently in different health care and public health settings and at different times of the year. And they give us different information and clues as to whether the H5N1 virus is present.

4. In addition to detecting viruses in individual animals and people, surveillance systems are set up to look for changes in the virus that might impact how the virus behaves or how well our current tools work, such as mutations that affect the ability of diagnostic tests to detect the virus or make antivirals and potential vaccines less effective.

5. Wastewater monitoring is one surveillance tool that provides community-based insights into how much influenza is circulating in an area by detecting viruses shed in feces. It has been used for other infectious diseases, including polioviruses and respiratory viruses like SARS CoV2, to identify viral presence before clinical cases spike in communities.

6. The Centers for Disease Control and Prevention (CDC) National Wastewater Surveillance System connects wastewater testing at more than 1,200 municipal treatment plants in all 50 states in the U.S., representing around a third of the U.S. population.

7. Since summer 2024, specific testing for H5 in wastewater has been implemented across more than 150 sites in 41 states and test results are shared with the CDC weekly.

8. While clinical testing of samples remains an important method of detecting influenza in individuals, communities and individuals with limited health care access can be left vulnerable and the burden not well understood, spotlighting the importance and value of community-based wastewater surveillance.

9. The alignment of various surveillance methods presents operational and data interpretation challenges but offers opportunities for more targeted and effective public health strategies, such as early, proactive testing in communities at higher risk.

10. The lessons drawn from previous experiences underscore the importance of early detection, especially before or in the absence of symptoms, and can be used to drive continuous improvements in H5N1 surveillance and diagnostics.

Listen to the full episode for a deep dive into the topic of wastewater monitoring with Dr. Broadhurst and Lauren Sauer.

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Resources for Health Care

• NETEC Influenza A (H5N1) Resources: https://repository.netecweb.org/exhibits/show/influenza/h5n1
• NETEC Resource Library: https://repository.netecweb.org