Antiviral Drugs in Wastewater-Based Epidemiology for Epidemic Surveillance and Alerting

Wastewater-Based Epidemiology (WBE) has provided critical surveillance and alerting during epidemic outbreaks such as COVID-19 through viral nucleic acid detection, yet it faces limitations including a narrow short detection time window and the potential for viral variants to escape. The high global incidence of viral diseases has driven increased consumption of antiviral drugs (AVDs). Serving as direct chemical signatures of diagnosis and treatment behaviors, AVDs offer new indicators for epidemic Surveillance and Alerting. This paper systematically outlines the scientific basis for applying AVDs in WBE-based alerting, analyzes core challenges such as data availability, target biomarker selection, and methodological standardization, and proposes a pathway of “Biomarker Validation-Technical Standard Harmonization -Methodologies Optimizing -Global Network Building”. This AVD-based WBE supports improving epidemic surveillance and alerting system.