{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T01:08:30Z","timestamp":1787620110967,"version":"build-2736575974"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Wastewater-based surveillance (WBS) of microbial pathogens has become an increasingly useful approach to monitor public health at the population level. However, these efforts varied widely in scope, methodology and focus within the GCC region. It remains unclear how WBS is being used across the region, and to what extent it can inform decision-making or contribute to long-term surveillance infrastructure within the GCC. This review aimed to critically assess WBS studies conducted across GCC and to provide perspective on how to further strengthen the ability of WBS to inform and provide early detection on the emergence of health concerns arising from microbial contaminants that are circulating in the community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This review was conducted following the PRISMA extension for scoping reviews guidance, aiming to identify and critically evaluate peer-reviewed studies that applied WBS across GCC between January 2015 and October 2025. A structured English-language literature search was carried out on the Web of Science, Scopus, and Google Scholar. Search results were screened against predefined inclusion and exclusion criteria. A survey was conducted with GCC stakeholders involved in the execution of wastewater surveillance, and their responses were studied to align actual WBS activities against that reported in the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 26 studies met the inclusion criteria for this review, with uneven distribution of studies published across the GCC countries (\n                      <jats:italic>n<\/jats:italic>\n                      = 6). The main targets reported in the WBS studies are antimicrobial resistance (AMR) and SARS-CoV-2. Majority of the studies report qualitative presence of microbial targets and lack quantitative measurements that are required to facilitate decision-making and intervention measures. Emerging methods and technology that can enable WBS were discussed to facilitate future WBS effort in GCC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although WBS holds significant promises to enhance public health surveillance in the GCC, its potential remains underutilized. Moving forward, addressing capacity training and providing sustainable long-term funding mechanisms, standardizing methodological differences and\/or providing a guideline that detail the best practices, promoting a consortium-based surveillance system and initiating research that can facilitate the utilization of WBS data to inform decision-making processes would be crucial for the successful integration of WBS into the region's public health framework.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1786753","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:51:43Z","timestamp":1776837103000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Wastewater-based surveillance of microbial pathogens in GCC countries (2015\u20132025): a scoping review and questionnaire survey with stakeholders"],"prefix":"10.3389","volume":"14","author":[{"given":"Bushra","family":"Alghamdi","sequence":"first","affiliation":[{"name":"Gulf Center for Disease Prevention and Control, Gulf Health Council","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norah","family":"Albedah","sequence":"additional","affiliation":[{"name":"Gulf Center for Disease Prevention and Control, Gulf Health Council","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turki","family":"Almalki","sequence":"additional","affiliation":[{"name":"Gulf Center for Disease Prevention and Control, Gulf Health Council","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Almudarra","sequence":"additional","affiliation":[{"name":"Gulf Center for Disease Prevention and Control, Gulf Health Council","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasi","family":"Penttinen","sequence":"additional","affiliation":[{"name":"Gulf Center for Disease Prevention and Control, Gulf Health Council","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changzhi","family":"Wang","sequence":"additional","affiliation":[{"name":"Center of Excellence on Smart Health, King Abdullah University of Science and Technology (KAUST)","place":["Thuwal, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Ying","family":"Hong","sequence":"additional","affiliation":[{"name":"Center of Excellence on Smart Health, King Abdullah University of Science and Technology (KAUST)","place":["Thuwal, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1126\/science.ade2503","article-title":"Wastewater surveillance for public health","volume":"379","author":"Levy","year":"2023","journal-title":"Science"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e00103","DOI":"10.1128\/cmr.00103-22","article-title":"Wastewater-based surveillance as a tool for public health action: SARS-CoV-2 and beyond","volume":"37","author":"Parkins Michael","year":"2023","journal-title":"Clin Microbiol Rev."},{"key":"B3","doi-asserted-by":"publisher","first-page":"S294","DOI":"10.1093\/infdis\/jiu384","article-title":"Environmental surveillance for polioviruses in the Global Polio Eradication Initiative","volume":"1","author":"Asghar","year":"2014","journal-title":"J Infect Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"138875","DOI":"10.1016\/j.scitotenv.2020.138875","article-title":"Computational analysis of SARS-CoV-2\/COVID-19 surveillance by wastewater-based epidemiology locally and globally: feasibility, economy, opportunities and challenges","volume":"730","author":"Hart","year":"2020","journal-title":"Sci Total Environ."},{"key":"B5","doi-asserted-by":"publisher","first-page":"107171","DOI":"10.1016\/j.envint.2022.107171","article-title":"Systematic review of wastewater surveillance of antimicrobial resistance in human populations","volume":"162","author":"Chau","year":"2022","journal-title":"Environ Int."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1038\/s41467-019-08853-3","article-title":"Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage","volume":"10","author":"Hendriksen","year":"2019","journal-title":"Nat Commun."},{"key":"B7","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1093\/aje\/kwac175","article-title":"Wastewater surveillance for infectious disease: a systematic review","volume":"192","author":"Kilaru","year":"2023","journal-title":"Am J Epidemiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"130989","DOI":"10.1016\/j.jhazmat.2023.130989","article-title":"Wastewater-based epidemiology for comprehensive community health diagnostics in a national surveillance study: mining biochemical markers in wastewater","volume":"450","author":"Kasprzyk-Hordern","year":"2023","journal-title":"J Hazard Mater."},{"key":"B9","doi-asserted-by":"publisher","first-page":"100707","DOI":"10.1016\/j.coesh.2026.100707","article-title":"Antibiotic residues, resistant bacteria, and resistance genes in hospital wastewater from upper middle-income countries: a systematic review","volume":"50","author":"Kusuma","year":"2026","journal-title":"Curr Opin Environ Sci Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"5223","DOI":"10.1128\/AAC.00236-16","article-title":"Isolation and characterization of NDM-positive escherichia coli from municipal wastewater in Jeddah, Saudi Arabia","volume":"60","author":"Mantilla-Calderon","year":"2016","journal-title":"Antimicrob Agents Chemother."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.3390\/microorganisms11041038","article-title":"Pepper mild mottle virus as a potential indicator of fecal contamination in influents of wastewater treatment plants in Riyadh, Saudi Arabia","volume":"11","author":"Eifan","year":"2023","journal-title":"Microorganisms"},{"key":"B12","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1039\/C6EW00322B","article-title":"Removal of bacterial cells, antibiotic resistance genes and integrase genes by on-site hospital wastewater treatment plants: surveillance of treated hospital effluent quality","volume":"3","author":"Timraz","year":"2017","journal-title":"Environ Sci Water Res Technol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"4773","DOI":"10.3390\/ijerph18094773","article-title":"Human adenovirus molecular characterization in various water environments and seasonal impacts in Riyadh, Saudi Arabia","volume":"18","author":"Nour","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"110748","DOI":"10.1016\/j.envres.2021.110748","article-title":"Estimating the minimum number of SARS-CoV-2 infected cases needed to detect viral RNA in wastewater: to what extent of the outbreak can surveillance of wastewater tell us?","volume":"195","author":"Hong","year":"2021","journal-title":"Environ Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"162466","DOI":"10.1016\/j.scitotenv.2023.162466","article-title":"SARS-CoV-2 wastewater-based epidemiology in an enclosed compound: a 25-year survey to identify factors contributing to local community dissemination","volume":"875","author":"Wang","year":"2023","journal-title":"Sci Total Environ"},{"key":"B16","doi-asserted-by":"publisher","first-page":"15007","DOI":"10.1021\/acs.est.2c01834","article-title":"Investigation of antibiotic resistome in hospital wastewater during the COVID-19 pandemic: is the initial phase of the pandemic contributing to antimicrobial resistance?","volume":"56","author":"Wang","year":"2022","journal-title":"Environ Sci Technol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.3390\/w15071367","article-title":"Molecular identification of human adenovirus isolated from different wastewater treatment plants in Riyadh, Saudi Arabia: surveillance and meteorological impacts","volume":"15","author":"Maniah","year":"2023","journal-title":"Water"},{"key":"B18","doi-asserted-by":"publisher","first-page":"25050","DOI":"10.1007\/s11356-021-14809-2","article-title":"Municipal wastewater viral pollution in Saudi Arabia: effect of hot climate on COVID-19 disease spreading","volume":"30","author":"Alahdal","year":"2023","journal-title":"Environ Sci Pollut Res Int."},{"key":"B19","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1038\/s44221-025-00446-3","article-title":"Wastewater surveillance unveils the impact of mass gatherings on antimicrobial resistance after the COVID-19 pandemic in Saudi Arabia","volume":"3","author":"Wang","year":"2025","journal-title":"Nat Water."},{"key":"B20","doi-asserted-by":"publisher","first-page":"426","DOI":"10.3390\/antibiotics13050426","article-title":"Screening for antibiotic resistance genes in bacteria and the presence of heavy metals in the upstream and downstream areas of the Wadi Hanifah Valley in Riyadh, Saudi Arabia","volume":"13","author":"Al-Otaibi","year":"2024","journal-title":"Antibiotics"},{"key":"B21","doi-asserted-by":"publisher","first-page":"102775","DOI":"10.1016\/j.eti.2022.102775","article-title":"Application of human RNase P normalization for the realistic estimation of SARS-CoV-2 viral load in wastewater: a perspective from Qatar wastewater surveillance","volume":"27","author":"El-Malah","year":"2022","journal-title":"Environ Technol Innov"},{"key":"B22","doi-asserted-by":"publisher","first-page":"145608","DOI":"10.1016\/j.scitotenv.2021.145608","article-title":"COVID-19 (SARS-CoV-2) outbreak monitoring using wastewater-based epidemiology in Qatar","volume":"774","author":"Saththasivam","year":"2021","journal-title":"Sci Total Environ."},{"key":"B23","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.jhin.2023.08.011","article-title":"Wastewater-based epidemiology for tracking bacterial diversity and antibiotic resistance in COVID-19 isolation hospitals in Qatar","volume":"141","author":"Johar","year":"2023","journal-title":"J Hosp Infect."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e30267","DOI":"10.1016\/j.heliyon.2024.e30267","article-title":"Leveraging wastewater surveillance for managing the spread of SARS-CoV-2 and concerned pathogens during FIFA World Cup Qatar 2022","volume":"10","author":"El-Malah","year":"2024","journal-title":"Heliyon"},{"key":"B25","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/j.medj.2021.03.015","article-title":"Simultaneous detection and mutation surveillance of SARS-CoV-2 and multiple respiratory viruses by rapid field-deployable sequencing","volume":"2","author":"Bi","year":"2021","journal-title":"Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.jgar.2025.06.017","article-title":"First surveillance and draft genome sequences of circulating mcr-1-carrying, multidrug-resistant Escherichia coli in wastewater in Qatar","volume":"44","author":"Alhaj Sulaiman","year":"2025","journal-title":"J Glob Antimicrob Resist."},{"key":"B27","doi-asserted-by":"publisher","first-page":"2562","DOI":"10.3390\/w12092562","article-title":"Occurrence of extended spectrum beta-lactamase gram-negative bacteria from non-clinical sources in Dubai, United Arab Emirates","volume":"12","author":"Khan","year":"2020","journal-title":"Water"},{"key":"B28","doi-asserted-by":"publisher","first-page":"163785","DOI":"10.1016\/j.scitotenv.2023.163785","article-title":"Long-term study on wastewater SARS-CoV-2 surveillance across United Arab Emirates","volume":"887","author":"Wadi","year":"2023","journal-title":"Sci Total Environ."},{"key":"B29","doi-asserted-by":"publisher","first-page":"142929","DOI":"10.1016\/j.scitotenv.2020.142929","article-title":"Detection and quantification of SARS-CoV-2 RNA in wastewater and treated effluents: surveillance of COVID-19 epidemic in the United Arab Emirates","volume":"764","author":"Hasan","year":"2021","journal-title":"Sci Total Environ."},{"key":"B30","doi-asserted-by":"publisher","first-page":"143350","DOI":"10.1016\/j.scitotenv.2020.143350","article-title":"First confirmed detection of SARS-COV-2 in untreated municipal and aircraft wastewater in Dubai, UAE: the use of wastewater based epidemiology as an early warning tool to monitor the prevalence of COVID-19","volume":"760","author":"Albastaki","year":"2021","journal-title":"Sci Total Environ."},{"key":"B31","doi-asserted-by":"publisher","first-page":"101226","DOI":"10.1016\/j.envc.2025.101226","article-title":"First national study on genomic profiling of Escherichia coli in United Arab Emirates (UAE) aquatic environments shows diverse quinolone and cephalosporin resistance","volume":"20","author":"Papadopoulou","year":"2025","journal-title":"Environ Chall."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1366","DOI":"10.3390\/antibiotics12091366","article-title":"Antibiotic resistance mediated by Escherichia coli in Kuwait marine environment as revealed through genomic analysis","volume":"12","author":"Al-Sarawi","year":"2023","journal-title":"Antibiotics"},{"key":"B33","doi-asserted-by":"publisher","first-page":"11325","DOI":"10.3390\/su141811325","article-title":"Antimicrobial resistance in Escherichia coli isolated from marine sediment samples from Kuwait Bay","volume":"14","author":"Al-Sarawi","year":"2022","journal-title":"Sustainability"},{"key":"B34","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1007\/s10661-023-10986-4","article-title":"Detection of pathogenic viruses in the urban wastewater in Kuwait\u2014implications for monitoring viral disease outbreaks","volume":"195","author":"Jamil","year":"2023","journal-title":"Environ Monit Assess."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e13194","DOI":"10.1111\/irv.13194","article-title":"Presence of SARS-CoV-2 virus in wastewater in the Kingdom of Bahrain during the COVID-19 pandemic","volume":"17","author":"Mohamed","year":"2023","journal-title":"Influenza Other Respir Viruses"},{"key":"B36","doi-asserted-by":"publisher","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann Intern Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"845448","DOI":"10.3389\/fenvs.2022.845448","article-title":"Characterizing the chemical contaminants diversity and toxic potential of untreated wastewater from a drug rehabilitation hospital: understanding impact on downstream environment","volume":"10","author":"Baasher","year":"2022","journal-title":"Front Environ Sci"},{"key":"B38","doi-asserted-by":"publisher","first-page":"139960","DOI":"10.1016\/j.scitotenv.2020.139960","article-title":"Comparison of virus concentration methods for the RT-qPCR-based recovery of murine hepatitis virus, a surrogate for SARS-CoV-2 from untreated wastewater","volume":"739","author":"Ahmed","year":"2020","journal-title":"Sci Total Environ."},{"key":"B39","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1373\/clinchem.2008.112797","article-title":"The MIQE guidelines: minimum information for publication of quantitative real-time PCR experiments","volume":"55","author":"Bustin","year":"2009","journal-title":"Clin Chem."},{"key":"B40","doi-asserted-by":"publisher","first-page":"9079","DOI":"10.1021\/es502615e","article-title":"High throughput profiling of antibiotic resistance genes in urban park soils with reclaimed water irrigation","volume":"48","author":"Wang","year":"2014","journal-title":"Environ Sci Technol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1021\/acs.est.8b03798","article-title":"AsChip: a high-throughput qPCR Chip for comprehensive profiling of genes linked to microbial cycling of arsenic","volume":"53","author":"Zhao","year":"2019","journal-title":"Environ Sci Technol."},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.00724-20","article-title":"Metagenomics as a tool to monitor reclaimed-water quality","author":"Hong","year":"2020","journal-title":"Appl Environ Microbiol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"14982","DOI":"10.1021\/acs.est.1c08673","article-title":"Demonstrating a comprehensive wastewater-based surveillance approach that differentiates globally sourced resistomes","volume":"56","author":"Prieto Riquelme","year":"2022","journal-title":"Environ Sci Technol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"6192","DOI":"10.1021\/acs.est.4c08284","article-title":"Evaluating quantitative metagenomics for environmental monitoring of antibiotic resistance and establishing detection limits","volume":"59","author":"Davis","year":"2025","journal-title":"Environ Sci Technol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"gkaf118","DOI":"10.1093\/nar\/gkaf118","article-title":"Development of a quantitative metagenomic approach to establish quantitative limits and its application to viruses","volume":"53","author":"Langenfeld","year":"2025","journal-title":"Nucleic Acids Res"},{"key":"B46","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.jprocont.2021.12.006","article-title":"Sliding window neural network based sensing of bacteria in wastewater treatment plants","volume":"110","author":"Alharbi","year":"2022","journal-title":"J Process Control."},{"key":"B47","doi-asserted-by":"publisher","first-page":"31218","DOI":"10.1038\/s41598-024-82598-y","article-title":"A calibration framework toward model generalization for bacteria concentration estimation in water resource recovery facilities","volume":"14","author":"Aljehani","year":"2024","journal-title":"Sci Rep"},{"key":"B48","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1038\/s41545-025-00461-7","article-title":"Viral particle prediction in wastewater treatment plants using nonlinear lifelong learning models","volume":"8","author":"Chen","year":"2025","journal-title":"NPJ Clean Water"},{"key":"B49","doi-asserted-by":"publisher","first-page":"123905","DOI":"10.1016\/j.watres.2025.123905","article-title":"Combining flow virometry with tree-based machine learning models for rapid virus particle estimation in different wastewater matrices","volume":"284","author":"Myshkevych","year":"2025","journal-title":"Water Res"},{"key":"B50","doi-asserted-by":"publisher","first-page":"7251","DOI":"10.1038\/s41467-022-34312-7","article-title":"Genomic analysis of sewage from 101 countries reveals global landscape of antimicrobial resistance","volume":"13","author":"Munk","year":"2022","journal-title":"Nat Commun."},{"key":"B51","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1038\/s44221-025-00444-5","article-title":"Augmentation of wastewater-based epidemiology with machine learning to support global health surveillance","volume":"3","author":"A\u00dfmann","year":"2025","journal-title":"Nat Water"},{"key":"B52","doi-asserted-by":"publisher","first-page":"122747","DOI":"10.1016\/j.watres.2024.122747","article-title":"Making waves: a justice-centred framework for wastewater-based public health surveillance","volume":"268","author":"Arefin","year":"2025","journal-title":"Water Res."},{"key":"B53","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1021\/acs.est.5c11553","article-title":"Monitoring cross-border dissemination of antimicrobial resistance (AMR) via air travel to Saudi Arabia: formulation of monitoring strategies to mitigate AMR concerns","volume":"60","author":"Wang","year":"2025","journal-title":"Environ Sci Technol."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1786753\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:51:48Z","timestamp":1776837108000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1786753\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":53,"alternative-id":["10.3389\/fpubh.2026.1786753"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1786753","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]},"article-number":"1786753"}}