Sewage research offers great potential for detecting diseases and specific substances. Working with the Ministry of Health, Welfare and Sport (VWS) and the regional water boards, RIVM is currently exploring whether sewage research will be expanded in the future.

This illustration shows the possibilities of sewage research. Further research will need to show which applications are useful and feasible.

Sewage as an indicator of public health

View infographic: Sewage as an indicator of public health (PDF, 529 KB)

Infectious diseases

Some existing and emergent infectious diseases can be found in sewage. RIVM is conducting sewage research to monitor the spread of the coronavirus SARS-CoV-2 (the virus that causes COVID-19), but it has more potential, for example in researching influenza or measles.  If sewage surveillance detects high levels of a virus that causes an infectious disease, that could be a reason to prioritise vaccinating people against that disease. 


A certain substance called 8-isoprostan can be found in urine. If high levels of this biomarker are found in sewage, this could offer information about how many people have diabetes or a pre-diabetic health condition. Municipalities could use that information to guide their health policies.   


An exceptional method can be used to predict obesity (severe overweight) through sewage research. A specific combination of bacteria (microbial communities) can be an indicator of obesity in a specific city or region. Government authorities at the municipal, regional and national level can use that information to deploy targeted interventions aimed at preventing and fighting obesity.  


Some forms of cancer can be detected by DNA analysis. It may be possible to trace those biomarkers in sewage. Data from sewage research could contribute to early detection, making it possible to issue warnings for a specific region.  

Healthy lifestyle

Stress hormones and alcohol and nicotine by-products can also be detected in sewage. The National Prevention Agreement (NPA) defines targets for the population of the Netherlands.  One of those targets is to reduce the number of smokers from 23% to 5% by 2040. RIVM has the task of monitoring the relevant lifestyle indicators. Options can be explored for the extent to which sewage research can support these monitoring activities. RIVM can also measure alcohol levels in sewage. Reducing alcohol consumption is another target defined in the National Prevention Agreement.  Sewage research could offer a helpful supplement to other forms of research on lifestyle.