A scoping review of operational characteristics and public health applications of aviation wastewater surveillance

Surveillance of wastewater from airplanes and airports has emerged as a promising tool to monitor pathogen importation. While these strategies expanded during the COVID-19 pandemic, most efforts remained proofs-of-concept, and few have become institutionalized. Airport and airplane wastewater sampling involve distinct operational constraints, partnership networks, and surveillance roles, which must be understood to inform sustainable system design. We conducted a scoping review following PRISMA-ScR guidelines. 41 studies from 20 countries were retrieved from PubMed, Embase and manual searches, describing first-hand efforts to detect pathogens in wastewater from airplanes, intermediate collection points, airport terminals, or airport-adjacent wastewater treatment plants. Data were extracted using a framework adapted from the U.S. Centers for Disease Control and Prevention’s surveillance system evaluation concepts, covering purpose, operational characteristics, stakeholder roles, analytical challenges, and public health applications. Aviation wastewater was demonstrated as a reliable source for early-warning, often detecting SARS-CoV-2 variants days to weeks ahead of clinical or municipal wastewater surveillance. Airplane and airport wastewater surveillance emerged as complementary approaches; while airplane wastewater provided targeted insight into pathogen importation and flight origins, airport wastewater reflected broader patterns of local transmission. Together, they provide situational awareness at the interface between global mobility and community spread. This scoping review presents the first synthesis of published literature on aviation wastewater surveillance comparing airplane and airport sampling across operational and epidemiologic characteristics. Realizing aviation wastewater’s full potential requires coordinated partnerships, expansion of initiatives to new regions, and clear pathways for translating signals into public health action.