Your wastewater could reveal norovirus outbreaks

Illustration: Annelise Capossela/Axios

Leading wastewater surveillance firm Biobot Analytics is now able to monitor for norovirus, Axios is first to report.

Why it matters: Norovirus — which typically causes gastrointestinal symptoms such as diarrhea and vomiting — is a little-understood yet highly communicable (and sometimes fatal) disease.

• A recent major outbreak seems to have spiked in mid-March, per the latest Centers for Disease Control and Prevention data — but norovirus isn't well-tracked at the local or state level.

The big picture: It's the latest expansion for Biobot and wastewater surveillance technology more broadly, which rose to prominence during the height of the COVID-19 pandemic as a key public health tool.

• After making a name for itself in tracking SARS-CoV-2 (the virus that causes COVID-19), Biobot expanded into monitoring for mpox (commonly known as monkeypox) as well as substances such as fentanyl and methamphetamines.
• Wastewater analysis has also been used to track poliovirus.

How it works: Biobot works with cities, states and so on to monitor wastewater for signs of a particular pathogen or substance.

• In the case of COVID-19, wastewater data often predicted spikes in positive tests, as those infected can shed the virus in their feces and urine before developing symptoms and getting tested.

Where it stands: Biobot has yet to announce any particular communities that have signed up for norovirus monitoring.

• It's offering the new service to existing customers beginning next month, with a broader rollout to follow.

What they're saying: Biobot CEO and co-founder Mariana Matus says her company's data could help researchers learn more about norovirus while offering a kind of early warning system for public health officials as the pathogen ebbs and flows.

• "It's very important to keep an eye on how those trends are changing season to season, year to year," Matus tells Axios.
• "And wastewater can allow you to do that in a way that is not biased," she adds — meaning data is collected from entire communities, rather than only from those who can access testing.

Yes, but: Wastewater monitoring provides a big-picture look at viral spread, rather than specific case counts or hyper-focused geographic data.

• Some epidemiologists, meanwhile, have been slow to embrace new tools such as wastewater monitoring.

Reality check: Wastewater analysis is best used for pathogens that are primarily shed in stool or urine, says Colleen Naughton, an assistant professor at the University of California, Merced.

• But other conditions, including those that cause respiratory secretions, sores or lesions, can show up after infected people shower or bathe.
• Naughton also cautioned that wastewater analysis risks becoming more commonplace in wealthier areas absent efforts to ensure equitable deployment.

What's next: Matus named several other diseases or conditions that could one day be picked up in wastewater, including RSV, e. coli, salmonella and sexually transmitted infections.

• But the big dream: Scanning "agnostically" for anything alarming, rather than setting out to identify something specific — including "new outbreaks that nobody expected," she says.
• "That's how the field is moving, and really fast."

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