Wastewater pathogen composition in Atlanta, GA prior to and during the 2026 FIFA World Cup

Mass gatherings can have many impacts on public health, including facilitating the spread of infectious diseases. Alternative surveillance modalities, such as wastewater-based surveillance (WBS), can complement traditional clinical surveillance. We utilized WBS to examine the influence of the 2026 FIFA World Cup (FWC'26) on the range of infectious pathogens in Atlanta, GA surrounding matches held in the city. Samples (n = 102) were collected from three water reclamation facilities between April and July of 2026 (34 collection days) and tested using the BIOFIRE® WATCHFIRE™ Respiratory (19 targets) and Gastrointestinal (22 targets) PCR Pathogen Panels. Primary data analysis included a temporal comparison of wastewater pathogen profiles before (April 1 to June 10; n = 60) and during (June 15 to July 15; n = 30) the FWC'26 across the three facilities using a modified Poisson model with Bonferroni correction. There were no statistically significant differences in target detection between the two periods. Samples collected after the FWC'26 (July 20 to 29; n = 12) were included in a sensitivity analysis which showed a statistically significant increase in SARS-CoV-2 (RR = 3.21, 95% CI = 1.40-7.39; p = 0.01, p-adjusted = 0.048) during and after the tournament compared to before. However, this coincided with regional and national increases in SARS-CoV-2 detection in wastewater, suggesting ongoing community burden. Wide confidence intervals, lack of quantitative data, and limited data collection after the matches limit our conclusions. This study demonstrates the use of qualitative, multiplexed PCR assays for WBS during a mass gathering sporting event.