Alberta is dealing with a record highest measles outbreak, with 1,323 cases confirmed since first reports in March. This shocking figure is larger than the US’s total case counts at their peak. The majority of new infections are occurring among unimmunized people. So far this year, the province has seen over 100 hospitalizations due to the infectious disease. This trend is an unmistakable portent of an ominous public health crisis.
To combat this resurgence, researchers are turning to wastewater surveillance as a potential early detection method for the highly contagious measles virus. This creative approach comes on the heels of the successful use of similar technology applied during the COVID-19 pandemic. With the right approach, experts say wastewater monitoring could improve responses to public health threats and help track and control outbreaks before they become widespread.
Wastewater Surveillance as a Tool
The snapshot of the community provided by wastewater data helps the team understand how measles is spreading in the community. Every week, samples from 12 wastewater treatment plants around Alberta are processed through the provincial lab. In an effort to differentiate between wild-type measles viruses and vaccine-related shedding, researchers developed a test that’s able to do just that.
Dr. Lee emphasizes the relevance of this approach, stating, “Wastewater surveillance was shown to be very useful globally — internationally — during COVID-19.” The approach reopens a dimension of active monitoring that has the potential to supplement more traditional, less resource-intensive public health responses.
Challenges remain. Due to logistical limitations, we are only able to conduct testing weekly as opposed to daily. This has huge implications for being able to monitor in real time. The incubation period for measles may extend up to two weeks, making immediate response efforts even more difficult.
Public Health Implications
Wastewater surveillance impacts go beyond just being able to detect something to help public health officials make better decisions and provide guidance on what to do. Dr. Xiaoli Pang, a professor at the University of Alberta and former virologist, highlights the need for correlation between clinical information and wastewater data: “We want to get clinical information … to compare the correlation. Are we really able to do earlier detection and provide useful information to public health [so they can] make some kind of decisions?”
Given the current uptick in measles activity in Alberta, public health experts are starting to worry about a future return. Dr. Pang asserts, “Basically we have a lot of measles activity and it’s increasing,” indicating that the situation could escalate if not addressed promptly.
Future Strategies
Moving forward, researchers are encouraged by the possibility for wastewater surveillance to become an essential tool in epidemic preparedness. Dr. Pang concludes, “Something may be new coming. If something really causes a huge problem in the near future, I think wastewater [will] play some kind of important role.” He notes that while wastewater monitoring is beneficial, it is not a standalone solution: “It’s never useful by itself. It will always be useful as a supplementary surveillance tool.”
The full-featured Alberta is already hard at work addressing its significant measles outbreak. Wastewater monitoring is an important part of this multi-faceted public health strategy. This proactive approach has the potential to offer invaluable early warnings and prevent further spread of this highly contagious virus.
