Wastewater Surveillance’s Role in Identifying Measles Outbreaks

Utah's public health laboratory is using wastewater surveillance as an additional tool to track measles transmission across the state, according to Kelly Oakeson, PhD, chief scientist for Next Generation Sequencing and Bioinformatics at the Utah Public Health Lab. He spoke at the ongoing ASM Microbe conference in Washington DC on this topic.

Oakeson described how the state's surveillance infrastructure collects samples from communities across Utah to detect measles virus RNA in wastewater.

"We're doing two different techniques in Utah with our wastewater sites to monitor measles in the wastewater, so we've got 35 collection sites across the state of Utah, covers most of the state geographically, and we're doing a PCR assay as well as sequencing to detect measles in the wastewater and quantify how much measles RNA is there," Oakeson said.

“We're doing the sequencing to then track where these measles are coming from and how the outbreak is expanding. And then we're feeding all this data into the public health system, so our epidemiologist can then use that data to help track the outbreak, prevent the outbreak, and do that case investigation, so we know how cases are spreading.”

The surveillance network is designed to complement traditional public health reporting by providing population-level data on viral circulation, including in communities where cases may not yet have been identified through clinical testing.

Sequencing Adds Insight Into Viral Spread for Public Health

Beyond detecting the presence of measles virus, Utah's program also uses genomic sequencing to better understand transmission patterns and viral diversity.

"If we can monitor trends over time, we can detect cases in parts of Utah where we may not have good access to healthcare information, or people may not be getting tested, also gives us a bit of a head start, right, on seeing where new cases might arise based on concentrations of measles RNA in the wastewater," Oakeson said. This can be especially helpful in alerting clinicians and health officials so they can communicate with their patients and the public around vaccination.

“It allows us to give those local health jurisdictions a heads up, [and report to them] ‘hey, you got measles in your wastewater, you might start seeing clinical cases soon.’ But then we've also had stories where pediatricians have been using the wastewater data that we've made publicly available to help people get vaccinated,” he said.

According to Oakeson, combining PCR testing with sequencing allows public health officials to not only identify measles activity but also to evaluate genetic differences among detected viruses, helping inform outbreak investigations and response efforts.

“We can differentiate between a wild type strain, like D8 which is what's currently causing the outbreak in Utah, vs a vaccine strain, which we can see in wastewater [to determine] is what we're seeing because of the outbreak, because people are getting vaccinated, or is this a different strain that may be an introduction from international travel or a new introduction into Utah that isn't associated with the outbreak? So it gives us that level of detail we need to really target our actions,” he said.

Reference
The 2025-26 Measles Outbreak: a Multi-State Genomic Analysis. Oakeson K. Presented at ASM Microbe 2026. June 4-7, 2026. Washington DC.