For decades, disease surveillance has relied on hospitals, clinics, and laboratories reporting confirmed patient diagnoses to public health agencies. This traditional model works — but only once someone has already fallen ill. In an era of rapidly spreading infections and reemerging diseases, public health leaders are looking for ways to detect outbreaks before the first patient shows up in the emergency room.
Enter wastewater-based epidemiology (WBE) — the science of testing community sewage for genetic traces of viruses, bacteria, and chemical indicators. What began as a tool for tracking COVID-19 has evolved into one of the most powerful early-warning systems in modern epidemiology.
This fall, Colorado made national headlines by becoming one of the first U.S. states to extend wastewater testing to measles, signaling a broader shift toward continuous, population-level infectious disease monitoring.
For laboratories like CMDC Labs, this development represents both a scientific and societal milestone — where microbiology, molecular testing, and data-driven transparency come together to protect public health at the community scale.
Why Measles Is Back on the Radar
Measles was once declared eliminated in the United States in 2000. But in the past decade, declining vaccination rates, international travel, and misinformation have contributed to a steady resurgence. In 2024 and 2025 alone, several U.S. states reported localized outbreaks — mostly among unvaccinated populations — prompting renewed concern among public health authorities.
Unlike respiratory illnesses like influenza or COVID-19, measles is exceptionally contagious, with one infected person capable of transmitting the virus to 9 out of 10 susceptible individuals they contact. Because symptoms appear several days after exposure, outbreaks can spread silently through communities before being detected.
That’s where wastewater testing comes in.
How Wastewater Testing Detects Measles
When people are infected with measles, their bodies shed viral RNA in waste — even before symptoms like rash or fever appear. By collecting and analyzing wastewater samples from sewer systems, scientists can detect these viral fragments using molecular methods such as reverse transcription polymerase chain reaction (RT-PCR).
In Colorado’s pilot program, samples from wastewater treatment plants across several counties are now being screened for measles RNA alongside other pathogens like SARS-CoV-2, norovirus, and poliovirus.
This approach allows health authorities to:
- Identify infection trends before clinical cases are reported.
- Target vaccination outreach in high-risk communities.
- Allocate resources efficiently, such as mobile testing clinics or educational campaigns.
Wastewater testing effectively turns an entire community’s sewer system into a passive surveillance tool — continuously collecting health data without relying on individual testing or reporting.
The Science Behind the Signal
The process of detecting measles in wastewater involves several carefully controlled stages, each requiring rigorous analytical validation:
- Sample Collection and Preservation
Wastewater samples are collected from influent streams at treatment plants or lift stations. Proper preservation — including cooling and pH control — is essential to prevent RNA degradation. - Concentration and Extraction
Viral particles are often present at low concentrations, so laboratories use filtration and centrifugation techniques to concentrate the sample. Specialized reagents then extract viral RNA while removing inhibitors that could interfere with downstream testing. - Molecular Detection (RT-PCR or qPCR)
Using primers specific to the measles virus genome, labs amplify trace RNA fragments to detectable levels. The resulting amplification curve indicates whether measles genetic material is present — and, when quantified, can even estimate viral load trends. - Data Interpretation and Reporting
Positive detections are verified through controls and replicates before being reported to public health agencies. Over time, trend data helps identify whether infections are emerging, declining, or isolated events.
This integration of environmental science, molecular biology, and epidemiology is what makes wastewater testing such a powerful tool for population-level monitoring.
CMDC Labs’ Role: Turning Environmental Data into Public Health Insight
As the demand for wastewater testing expands, laboratories must evolve from traditional clinical diagnostics to environmental microbiology and molecular surveillance. CMDC Labs is at the forefront of that evolution — bridging the gap between raw environmental samples and actionable health intelligence.
Here’s how CMDC Labs supports public health agencies, municipalities, and research partners:
1. Advanced Microbiology and Molecular Testing Platforms
CMDC’s state-of-the-art testing facility combines quantitative PCR (qPCR) and digital PCR (dPCR) technologies to achieve ultra-sensitive detection of viral RNA in complex matrices like wastewater.
These molecular tools allow for:
- Detection of multiple pathogens (measles, norovirus, SARS-CoV-2, poliovirus, etc.) in a single run.
- Differentiation between viral strains.
- Quantitative viral load assessment for trend tracking.
2. Standardized Sampling and Chain-of-Custody Procedures
Accurate wastewater analysis starts in the field. CMDC works with municipal and utility partners to establish EPA-compliant sampling protocols, ensuring that every sample is representative, traceable, and contamination-free.
Proper chain-of-custody documentation allows data to hold up under regulatory review and cross-agency collaboration.
3. Cross-Contaminant Screening (PFAS, Metals, and Microbes)
While the focus is on infectious agents, CMDC’s integrated lab capabilities allow for multi-contaminant analysis within the same sample.
This enables comprehensive community health insights — linking microbial data with environmental indicators such as PFAS, heavy metals, or nutrient overloads that may influence immune vulnerability or disease spread.
4. Real-Time Data Integration and Reporting
Modern surveillance requires speed. CMDC’s digital data systems can transmit validated results to health departments and utility managers in near real-time.
Trend dashboards allow clients to visualize pathogen levels across sampling points and time periods, providing a dynamic picture of community health.
5. Partnership for Public Communication and Education
Scientific data only builds trust if it’s communicated clearly. CMDC assists local agencies in preparing public-facing reports that translate laboratory results into understandable insights for residents — fostering transparency and community confidence.
Why Independent Testing Matters
While many utilities have internal labs, independent testing from certified laboratories like CMDC ensures unbiased, validated results that meet both scientific and regulatory standards.
For public agencies, this independence is essential when:
- Confirming outbreak signals detected in municipal or academic pilot programs.
- Meeting grant or funding requirements for third-party verification.
- Communicating credible data to communities and the media.
Independent validation reinforces the reliability of public health decisions — and ultimately strengthens community trust in the system.
Wastewater Surveillance Beyond COVID-19
COVID-19 demonstrated that wastewater surveillance can be a real-time indicator of disease activity — often predicting clinical case surges by one to two weeks. Now, the same model is being expanded to a growing list of targets:
- Poliovirus: Early detection has enabled rapid vaccination campaigns in New York and London.
- Influenza and RSV: Seasonal tracking helps health systems anticipate hospitalization rates.
- Antimicrobial Resistance (AMR): Wastewater testing can monitor antibiotic-resistant genes, offering insights into emerging resistance trends.
- Enteric and Noroviruses: Continuous monitoring supports foodborne illness prevention and water safety efforts.
By adding measles to the surveillance roster, Colorado’s initiative confirms that WBE is not just a pandemic-era tool — it’s a long-term pillar of environmental public health intelligence.
Challenges and Opportunities Ahead
While the promise of wastewater-based disease monitoring is immense, it’s not without challenges.
- Analytical Complexity: Wastewater is a heterogeneous mix of organic and inorganic materials that can degrade viral RNA. Laboratories must continuously refine extraction and detection methods to maintain accuracy.
- Standardization Gaps: Unlike clinical testing, there are limited global standards for wastewater pathogen analysis. CMDC advocates for method harmonization across states and agencies to enable comparable, defensible data.
- Data Interpretation: Detecting viral fragments doesn’t always indicate infectiousness. CMDC’s scientific teams collaborate with epidemiologists to contextualize results — distinguishing between transient detections and sustained community transmission.
- Infrastructure and Equity: Rural and low-income areas may lack wastewater sampling access points or laboratory partnerships. CMDC supports public programs that expand surveillance capacity equitably, ensuring all communities benefit from early-warning systems.
Despite these hurdles, each challenge represents an opportunity for innovation — particularly in the integration of laboratory science, field sampling automation, and data analytics.
From Early Detection to Early Action
The greatest advantage of wastewater testing is time. Early detection means more time to respond — whether by ramping up vaccination drives, issuing targeted health alerts, or mobilizing field investigations.
In a pathogen’s life cycle, days can make the difference between a localized incident and a community-wide outbreak. CMDC Labs’ proactive testing framework helps convert those early molecular signals into decisive public health actions.
- For municipalities, this means identifying hotspots before outbreaks escalate.
- For state health departments, it means allocating resources strategically.
- For the public, it means transparency, reassurance, and trust.
Wastewater testing doesn’t replace clinical surveillance — it enhances it, turning invisible signals into visible action plans.
Building the Future of Community Health Monitoring
The future of public health surveillance will be data-driven, decentralized, and community-connected. Wastewater analysis embodies all three principles.
CMDC Labs envisions a collaborative model where laboratories, utilities, and local governments share data through interoperable platforms — enabling faster, smarter, and more transparent public health decision-making.
As infectious diseases evolve and new environmental challenges emerge, laboratories will remain the foundation of preparedness. Through scientific precision and public accountability, CMDC Labs continues to advance a simple but powerful mission:
To protect community health by ensuring that every drop of water tells a story — and that story is grounded in data, not uncertainty.
Sources: CPR News, CDC.gov, EPA.gov, NIH Wastewater Surveillance Research, Colorado Department of Public Health & Environment (CDPHE)
