Wastewater Surveillance Sentinel Monitoring Program

Fentanyl Surveillance Status

Governor Glenn Youngkin’s Executive Order 26 directed the Virginia Department of Health (VDH) to develop a cost-effective plan to utilize and fund wastewater surveillance to detect the frequency, potency, and occurrences of fentanyl use in specific locations. In response, VDH has developed a draft plan that was submitted to the Secretary of Health and Human Resources on August 28, 2023. The Virginia Department of Health (VDH)’s Wastewater Surveillance Program (VDH-WWS), in concert with the Office of the Medical Examiner (OCME) and the Department of Forensic Sciences (DFS), has selected fentanyl and norfentanyl as the analytes for monitoring in the proposed wastewater surveillance program. VDH has proposed a five-year two-prong approach to fentanyl monitoring: i) broad community monitoring at the influent to wastewater treatment plants, and ii) targeted subsewershed monitoring to focus on particularly vulnerable communities. VDH-WWS will coordinate with the Office of Epidemiology (OEPI) and the Office of Family Health Services (OFHS) to adjust sampling locations based on the most current fentanyl data as the project progresses. There is no projected start date for the sampling as we have not yet secured funding

Program Background

SARS-CoV-2 is the virus that causes COVID-19. Virus particles can be shed in feces (stool) by people infected with COVID-19 even before symptoms develop. People with no symptoms (asymptomatic infection) can also shed the virus in feces. Wastewater, or sewage, is water from toilets, showers, kitchens, and laundries used by our homes, businesses, and schools. The area served by a wastewater treatment plant is called a “sewershed.” Public health can count the amount of SARS-CoV-2 virus in wastewater because of this “fecal shedding”. By the time the virus leaves the body in feces, it is no longer active and cannot cause new COVID-19 infections. CDC has no reports of COVID-19 cases from wastewater.

Public health can use wastewater surveillance to learn more about the burden of COVID-19 in the community. Wastewater surveillance can show if COVID-19 is increasing or decreasing in the community 6 to 14 days before a COVID-19 diagnosis. This type of public health surveillance can be used as an early warning tool to watch for changes.

VDH collects samples from 36 wastewater treatment plants in Virginia each week. Wastewater surveillance started on September 13, 2021. This represents a population of approximately 4.3 million people. Virginia has more than 1,250 wastewater treatment plants, but with the 36 being sampled, over one-third of the population is represented by the current program. The samples are collected at the wastewater treatment plant before any significant processing by the facility. The Virginia Department of Consolidated Laboratory Services (DCLS) tests each sample for SARS-CoV-2 virus. The amount (concentration) of the virus shows how much COVID-19 is in the communities served by that wastewater treatment plant.

VDH is participating in a Centers for Disease Control and Prevention (CDC) Epidemiology and Laboratory Capacity (ELC) cooperative agreement to implement enhanced surveillance of SARS-CoV-2 in wastewater to augment other COVID-19 surveillance data to inform epidemiologic and public health needs. The CDC has initiated a National Wastewater Surveillance System (NWSS) that has been accepting data on wastewater surveillance from participating states. The states receive data from utilities and analytical laboratories and upload the data into the NWSS portal. VDH works with CDC to evaluate the data, look for ways to use the data to expand our understanding of COVID-19, create data dashboards, and otherwise use the data to combat COVID-19. VDH Wastewater Surveillance public-facing dashboard was released on May 19, 2023.

Caroline Marti, MPH – Data Analyst and Technical Support, caroline.marti@vdh.virginia.gov

Michelle Yancey, MPH – Data Manager, michelle.yancey@vdh.virginia.gov

Isaiah Omerhi, MPH – Environmental Epidemiologist, isaiah.omerhi@vdh.virginia.gov

Wastewater Surveillance for COVID-19

Wastewater Surveillance Sentinel Monitoring Program

Sample Collection and Laboratory Methods

Additional Resources and Opportunities

Frequently Asked Questions