Modern Biosurveillance Methods: A Lay Introduction to Effective Use of Nucleic Acid Methods

The devastating impact of the coronavirus disease 2019 (COVID-19) pandemic has led governments, health care institutions, and researchers to intensify their focus on developing improved means to detect, contain, and manage potential future outbreaks. As part of these efforts, policymakers and other nontechnical personnel need to understand available biosurveillance technologies. In this study, the authors summarize how current and emerging nucleic acid biosurveillance techniques work, describe their capabilities and limitations, and discuss the promise of emerging technologies. Biosurveillance systems are used to detect, monitor, and characterize health threats, or pathogens, in human and animal populations, food, wastewater, and the environment. Nucleic acid testing assesses nucleic acids, comprising deoxyribonucleic acid (DNA) and ribonucleic acid (RNA), to determine the biologic agents present in clinical samples (i.e., a sample collected by a medical laboratory from a symptomatic human) or environmental samples (e.g., wastewater). The authors describe a scenario of testing for pathogens in wastewater that uses detection technology within a comprehensive and pathogen-agnostic biosurveillance system. Wastewater testing offers a method for collecting samples without needing symptomatic individuals to present at clinics for care. Such testing can, therefore, offer data prior to symptoms and from those who have less access to clinical care. The case study demonstrates the advancements needed to develop a truly pathogen-agnostic, cost-effective wastewater biosurveillance system. The authors conclude that policymakers interested in establishing a biosurveillance program should carefully evaluate their specific research questions and their resource limitations to determine which technology is best suited to their needs.