Wastewater testing during the South African 2022-2023 measles outbreak demonstrates the potential of environmental surveillance to support measles elimination

Abstract

Background Sensitive clinical surveillance and high vaccination coverage are required to meet the WHO 2030 measles elimination target. Whilst wastewater and environmental surveillance (WES) has proven usefulness in polio surveillance, it has not been applied to measles control. We describe the development of digital RT-PCR (RT-dPCR) for detection and quantification of measles virus (MeV) in wastewater, and application to retained concentrated samples obtained from 28 national sentinel SARS-CoV-2 wastewater surveillance sites and 19 localised collection points in a single province before, during and after a measles outbreak of over 2,000 laboratory-confirmed cases.