Clinical Scorecard: Monitoring Disease Outbreaks on Military Vessels Through Wastewater Surveillance: A Strategy for Deployed Armed Forces Members

At a Glance

Key Highlights

• Wastewater surveillance has been successfully implemented in military bases, training centers, and vessels to detect SARS-CoV-2.
• Surveillance programs can be conducted by personnel without advanced microbiological training using emerging technologies.
• Wastewater surveillance is cost-effective compared to clinical testing and enables early outbreak detection and mitigation.

Guideline-Based Recommendations

Diagnosis

• Leverage wastewater surveillance to supplement existing COVID-19 surveillance systems as recommended by the USD(P&R).
• Use metagenomic strategies like VirCapSeq-VERT for broad viral detection in wastewater samples.

Management

• Implement wastewater surveillance programs on military vessels and training centers to enable timely outbreak response.
• Ensure personnel are trained to conduct wastewater sampling and analysis without requiring advanced microbiological expertise.

Monitoring & Follow-up

• Conduct regular biweekly wastewater sampling campaigns to monitor viral presence and trends.
• Use wastewater data to inform swift shipboard decisions to mitigate viral spread during outbreaks.

Risks

• Limited preparedness of medical personnel onboard vessels to handle infectious diseases beyond first aid.
• Challenges in sampling and analysis on seaborne vessels require tailored approaches.
• Ethical considerations unique to military settings must be addressed when implementing surveillance.

Patient & Prescribing Data

Military personnel aboard ships and at training centers exposed to confined living conditions

Wastewater surveillance provides early detection of outbreaks, enabling targeted isolation, quarantine, and medical interventions to reduce morbidity and mortality.

Clinical Best Practices

• Adopt wastewater surveillance as a complementary tool alongside clinical testing for infectious disease monitoring.
• Train non-expert military personnel in wastewater sampling and analysis techniques.
• Incorporate cost analyses to justify surveillance program implementation over widespread clinical testing.
• Address ethical and operational challenges specific to military environments in surveillance program design.

References

• USD(P&R) Coronavirus Disease 2019 Force Health Protection Guidance
• Wastewater Surveillance Studies on Military Bases and Vessels
• VirCapSeq-VERT Metagenomics Strategy
• Wastewater Surveillance on US Coast Guard Training Centers and Cutters
• SARS-CoV-2 Monitoring on French Aircraft Carrier PA Charles-de-Gaulle