wastewater-based epidemiology for infectious disease surveillance: a systematic review and meta-analysis focused on sars-cov-2, with narrative synthesis for other pathogens

Introduction: wastewater-based epidemiology (wbe) has emerged as a valuable approach for environmental management and public health surveillance. by detecting viral rna and biomarkers in wastewater, wbe provides community-level early warning signals that can support outbreak preparedness and guide policy-making.methods: we conducted a systematic review and meta-analysis according to the prisma 2020 guidelines. eligible studies published until march 2025 were screened from pubmed, web of science, and scopus. data on study design, sample type, detection methods, positivity rates, and temporal associations with clinical indicators were extracted. pooled positivity rates were calculated using random-effects models, heterogeneity was assessed, and subgroup analyses were conducted.results: twenty-nine studies on sars-cov-2 wastewater surveillance were included in this review. the pooled positivity rate was 59.5% (95% ci:49.6–68.7), with signals detected earliest in the sludge samples (98.8%). wastewater indicators preceded reported clinical cases by a median of six days. evidence has also demonstrated wbe’s applicability of wbe for influenza, rsv, norovirus, polio, and antimicrobial resistance, reinforcing its value beyond covid-19.