RIVM has been conducting sewage research for almost thirty years. Back in 1992, RIVM found the poliovirus in sewage samples. This discovery was made during a polio outbreak in an area where people were less willing to get vaccinated. Since then, RIVM has been investigating other things in sewage water, such as antibiotic-resistant bacteria. Since 2020, these research activities have included sewage surveillance to monitor the spread of SARS-CoV-2, the virus that causes COVID-19. All sewage treatment plants in the Netherlands are involved in this research. 

In future, sewage research may also be used for other diseases or topics. RIVM is currently consulting with the Ministry of Health, Welfare and Sport (VWS) and the regional water boards in the Netherlands to explore which options are available and what would be useful and feasible. 

What is sewage research?

It is often possible to see what is making people sick by examining their faeces and urine. This is why a doctor sometimes asks you to give a urine or stool sample as part of your medical examination. 

When we use the toilet, our faeces and urine enter the sewage system. Examining sewage samples makes it possible to learn a great deal about the health of the Dutch population. Sewage gives us information about various diseases, but also helps us learn more about lifestyle and living environment. 

By monitoring virus particles found in sewage, we can see where the coronavirus is spreading in communities and to what extent. Coronavirus monitoring in sewage research started on a small scale at the start of 2020, when the virus first appeared in the Netherlands. By now, sewage from more than 300 sewage treatment plants throughout the Netherlands is monitored. This research is part of the National Sewage Surveillance programme.

Why conduct sewage research? 

Sewage research offers a unique opportunity to learn more about all sorts of diseases and our own health. This is because a lot can be read from a person’s faeces and urine. Sewage can reveal whether a new infectious disease has appeared somewhere in the Netherlands. This applies to infectious diseases that can also be detected in faeces or urine. 

Sewage research is an important supplement to other forms of research. This form of research is anonymous, objective and does not place an additional burden on individuals. Moreover, almost all Dutch households are connected to the sewage system, which means that sewage gives reliable information about the population. 

Who is carrying out the sewage research? 

The sewage research is a joint project between RIVM and the 21 Dutch regional water boards and was commissioned by the Ministry of Health, Welfare and Sport (VWS). RIVM also partners with various water research laboratories, engineering firms, knowledge institutes and universities. 

What role does RIVM play in sewage research?

RIVM has years of experience in sewage research. This field of research is a good fit for RIVM, due to our wide-ranging expertise. RIVM combines knowledge about health, the environment and infectious diseases in a single organisation. 

What diseases or substances can be investigated in sewage?

Sewage can provide information about various diseases and substances at the local, regional and national levels.  This illustration offers an impression of the potential offered by sewage research. RIVM is currently consulting with the Ministry of Health, Welfare and Sport (VWS) and the regional water boards in the Netherlands to explore which options would be useful and feasible in the future. 

Sewage as an indicator of public health

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

Is it permitted to conduct research on sewage?

Through sewage research, we can learn a lot about people’s health without their knowledge. This raises an important question: is this allowed? What about privacy, for example? 

RIVM requested an independent assessment of whether the National Sewage Surveillance in the Netherlands complies with the legal frameworks for privacy, and whether it should be subjected to the medical ethics review that is required for research involving human subjects. This assessment showed that the National Sewage Surveillance is within the legal frameworks and that a medical ethics review is not necessary.

Although sewage research can provide a great deal of information at the local or regional level, it does not reveal anything about the health of individuals or households. The research is done using samples taken from over 300 sewage treatment plants in the Netherlands. Even the smallest sewage treatment plant (on the island of Schiermonnikoog) has over 900 local residents connected to its sewage system. Therefore, any virus particles in a sewage sample cannot be traced back to individuals or households.


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