Beyond Technical Feasibility: A Scoping Review of Operational and Strategic Dimensions of Aviation Wastewater Surveillance

Background Surveillance of wastewater from airplanes and airports has emerged as a promising tool to monitor the importation of pathogens from international travelers. Despite the rapid expansion of these strategies during the COVID-19 pandemic, most reported efforts focused on proofs-of-concept of analytical feasibility, and few initiatives have transitioned toward institutionalized systems. Airport and airplane wastewater sampling involve distinct operational constraints, partnership networks, and surveillance roles, and a clearer understanding of these differences is needed to inform sustainable system design. Methods We conducted a scoping review following PRISMA-ScR guidelines. 41 studies from 22 countries were retrieved from PubMed, Scopus and manual searches. They described first-hand efforts to detect pathogens in wastewater from airplanes, intermediate collection points, airport terminals, or airport-adjacent wastewater treatment plants. Data were charted using a framework inspired by CDC surveillance system evaluation concepts, covering purpose, operational characteristics, stakeholder roles, analytical challenges, and public health applications. Results Across studies, aviation wastewater was demonstrated as a reliable source for early-warning, often detecting SARS-CoV-2 variants days to weeks ahead of clinical or municipal wastewater surveillance. Airplane and airport wastewater surveillance emerged as complementary approaches; while airplane wastewater provided targeted insight into pathogen importation and flight origins, airport wastewater reflected broader patterns of local transmission. Used together, these approaches provide situational awareness at the interface between global mobility and community spread. Conclusions Aviation wastewater can strengthen global health preparedness. Realizing its full potential requires coordinated partnerships, expansion of initiatives to new regions, and clear pathways for translating signals into public health action.