Wastewater-based epidemiology biomarkers: Past, present and future

Wastewater is a complex matrix containing a wide range of chemical and biological markers of human activity. Relating concentrations of these “waste” materials in wastewater influent streams to population-scale use, consumption, or rates of exposure, can provide important qualitative or quantitative information on the activity of inhabitants within a given wastewater catchment. Many publications in this field of study have focussed on the usage of pharmaceuticals, illicit drugs, tobacco and alcohol. However, many other potential applications are emerging which can contribute useful knowledge on human health, exposure to industrial chemicals, infectious diseases or pathogens and antibiotic resistance. This review summarises the established wastewater based epidemiology (WBE) biomarkers, and presents a critical review of the current capabilities of WBE. We further discuss possible future strategies and challenges anticipated in analysing wastewater to measure chemical markers of population health as well as biological markers of microbial exposure and disease.