Tracking Measles Through Wastewater Monitoring

A tool that gained traction during the COVID-19 pandemic could assist communities in monitoring the spread of measles across the United States.

Angela Harris, an environmental engineer from North Carolina, describes wastewater monitoring as an effective “early warning system.” She clarifies, “Sometimes, people can spread these pathogens in their urine or stool before they even show symptoms. If we rely solely on clinical testing for symptomatic individuals, it may be too late.”

Harris, who is an associate professor at NC State, collaborated with the North Carolina Department of Health and Human Services during initial research efforts related to the SARS Co-V-2 pandemic.

“We had to think about how we could assist in the response and address transmission,” she said. “Wastewater provides a valuable sample type for examining community-level exposure.”

Different pathogens behave in unique ways. Harris pointed out that, for example, measles is shed through urine, not stool.

Wastewater has already been utilized to investigate other viruses, like polio and influenza, as well as to assess widespread drug usage.

Data from water treatment facilities proved beneficial for healthcare systems during the pandemic, helping them make informed decisions regarding elective procedures and managing rising case numbers.

A new resource called WastewaterSCAN is now available, offering additional insights into measles spread across the U.S. As of June 5, 2025, confirmed measles cases have reached 1,168 across 34 jurisdictions, with 89% linked to 17 different outbreaks this year.

All states surrounding North Carolina, except South Carolina, have reported at least one measles case in recent months.

However, Harris cautioned that the system has limitations. It tends to be more effective when several individuals within a community are impacted by the same disease.

“For instance, if 100,000 people are contributing to a wastewater treatment plant and only one is infected, the chances of detecting it are pretty low. But if you have around 100 infected individuals, the likelihood of detection rises to about 50%,” she elaborated.

Monitoring specific locations, like schools, hospitals, or nursing homes, could yield more precise data on viral spread.

“Certain buildings are connected to a single sewage line, so we can set up sampling devices within this network,” Harris mentioned. “In one neighborhood, all waste might funnel to a consolidated point, making it easier to install monitoring equipment.”

This data would also help health departments plan targeted outreach efforts effectively.

“By tracking wastewater and spotting particular disease trends, vaccination campaigns can be much more impactful in reducing the risk of transmission,” Harris noted. “Schools are an effective avenue for reaching families. If we observe certain trends in wastewater, health departments can collaborate with schools to provide relevant information and vaccination opportunities.”

Health officials are particularly worried about measles transmission among school-aged children.

Measles is highly contagious and poses significant risks for young kids. The CDC indicates that two-thirds of confirmed deaths from measles in 2025 involved children.

As of June 5, 2025, 67% of reported cases across 33 states involved individuals under 19, with 95% of these cases occurring in unvaccinated patients or those with unknown vaccination status.

Two doses of the measles vaccine offer around 97% effectiveness against measles, mumps, and rubella, according to the CDC.

Symptoms of measles include fever, cough, runny nose, and red, watery eyes, with a red, blotchy rash potentially appearing on the body.

Harris believes that wastewater tracking will become a valuable tool for health departments in the future, particularly when monitoring the community spread of measles.