Wastewater and environmental surveillance for : a scoping review.

There is growing interest in the utility of wastewater and environmental surveillance (WES) in supporting disease outbreaks, including the monitoring of . The objective of this scoping review was to describe the current evidence regarding the surveillance of in wastewater and wastewater-impacted environmental waters (including drinking water). We conducted a comprehensive electronic search, updated to January 2025. Following duplicate screening, we identified 114 eligible studies. The studies evaluated early WES warning systems, monitored trends in ongoing outbreaks, and described serogroups and virulent strains of toxigenic circulating in communities. Most studies were conducted in South-East Asia (44%), particularly India and Bangladesh, where cholera is endemic. A large proportion of studies detected subgroup O1 or O139, and numerous virulent strains such as . Studies were generally poorly reported, for example, inconsistent reporting on sample management, data reliability, and sampling frequency were common. WES has not been widely integrated into existing surveillance systems for real-time cholera monitoring. Our findings underscore the need for further clearly reported research to clarify the role of WES for early warning systems for cholera outbreaks, and to identify strategies that may optimise WES implementation for public health benefit.