Utilizing Wastewater-Based Surveillance to Monitor <i>Borrelia</i> sp. for the Detection of Lyme Disease in a Nonendemic Region of the United States

Wastewater-based surveillance (WBS) has emerged as a novel public health tool for monitoring the prevalence of community disease. There is great interest in expanding the list of potential targets to those that are difficult to clinically monitor. Lyme disease is the most common tick-borne illness in the United States, accounting for 82% of all clinically reported cases. It is also notoriously hard to diagnose and can become a chronic condition if not treated early. The objective of this study was to determine the feasibility of WBS to monitor Lyme disease and analyze sample data for trends in comparison with public health data, as reported by the Michigan Department of Health and Human Services. Wastewater samples were collected over the course of one year and molecular tests were implemented to detect Borrelia species, the causative bacteria of Lyme disease. Two Borrelia sp. targets (fliD and 16S rRNA) showed significant correlation (p = 0.0028; p < 0.05 is significant) with clinical disease trends (assessed at the county level), with WBS data lagging behind clinical data by 11 weeks. More data are needed to fully understand the connections between WBS data and clinical data. This represents the first study to monitor the causative agent of Lyme disease via WBS.