Aircraft wastewater surveillance as a tool for monitoring disease in the Pacific

Wastewater surveillance is a powerful tool for monitoring infectious diseases within a population. However, as most wastewater surveillance relies on interconnected wastewater networks to provide samples representative of the population, many Pacific Islands have been excluded from benefiting from this tool due to their lack of reticulated sewerage systems. Many diseases of concern for the Pacific are detectable in wastewater even though individuals may be asymptomatic. We investigated whether analysis of wastewater from aircraft arriving in New Zealand from Pacific Island nations could be used as a proxy for in-country surveillance. Flights from the Pacific arrive in Auckland daily, with more than 660,000 passenger arrivals during 2024 alone. We detected viral and bacterial targets in wastewater collected from 23 flights from six Pacific countries via quantitative PCR. As such, aircraft wastewater surveillance may provide practical and valuable support to in-country clinical surveillance, helping identify outbreaks and monitor trends over time.