Subject Area: Knowledge to Action Series

Rural and remote communities in Canada often face higher risks from infectious disease outbreaks due to limited access to timely testing and healthcare, multi-generational housing, and geographical isolation. Wastewater-based surveillance (WBS) offers a community-wide, non-invasive solution to detect respiratory viruses like SARS-CoV-2, influenza, and RSV early, helping local clinics act quickly and efficiently. This use case explains the usefulness of wastewater-based surveillance in the rural and remote Canadian context. This summarizes the findings reported in the literature and the case example from the WBS program of the Cree Board of Health and Social Services of James Bay. Since its inception during the COVID-19 pandemic, it has been monitoring viral spread in the region with minimal lab capacity. Community-led and grounded in OCAP principles, the program enables early warnings, supports clinical response, and conserves healthcare resources by reducing the need for widespread individual testing.

Long-term care (LTC) residents are particularly vulnerable to respiratory infections such as influenza, RSV, and pneumonia due to factors like advanced age, existing health conditions, and congregate living environments. The knowledge-to-action series on the cost-benefits of wastewater surveillance in long-term care looks at cost and benefit elements associated with wastewater-based surveillance in long-term care facilities. This report is based on literature findings and a single use case example of WBS in a Quebec long-term care home. WBS acts as an early warning system by detecting viral signals before clinical symptoms appear, allowing for earlier intervention. When used alongside clinical testing, WBS can reduce infections, hospitalizations, healthcare costs, and improve resident quality of life.

This case example discusses the cost-utility of the wastewater-based surveillance for Respiratory Syncytial Virus (RSV) in young children in Ontario before the RSV 2022-2023 season. WBS identified the start of RSV season 12-36 days earlier than the provincial start date, which was based on clinical testing. This early transmission was used to help inform resource allocation decisions across different healthcare settings. A CUA comparing the impact of RSV disease in immunized and non-immunized infants found WBS to be a cost-saving approach over clinical testing. WBS costs can be offset by savings from the reduced need for medical care. This RSV case study is an important demonstration of how harmonized sampling strategies, timely data reporting, and effective partnerships can enable public health action. By linking early, population-level detection with actionable clinical and policy responses, WBS yields measurable gains in health utility and health outcomes, while enhancing preparedness for future outbreaks.