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NIH grant 1K01AI199468-01: Monitoring M.tuberculosis through community wastewater
Institute: {'code': 'AI', 'abbreviation': 'NIAID', 'name': 'National Institute of Allergy and Infectious Diseases', 'admin_org_id': '12500003', 'admin_funding_url': ''}. PI: MERI VARKILA. Award: $154955.
Start: 2026-09-18T00:00:00.
PROJECT SUMMARY/ ABSTRACT
Tuberculosis (TB) is the leading infectious cause of death globally, with approximately 10 million new cases
and 1.5 million deaths annually. In the United States, TB incidence is rising for the first time in nearly two
decades. Traditional TB surveillance methods, which rely on clinical case detection, often result in reporting
delays and may overlook high-risk populations and asymptomatic cases, leading to an underestimation of the
true TB burden. This research aims to establish a novel framework for TB surveillance that effectively identifies
populations requiring enhanced screening through scalable and cost-effective strategies. Wastewater-based
epidemiology (WBE) presents a promising approach for timely and comprehensive disease prevalence
estimates within communities prior to clinical identification. While WBE has been successfully employed for
monitoring various pathogens, its application for TB surveillance remains underexplored. This study seeks to
assess the feasibility and utility of WBE for systematic TB monitoring across varying disease incidence and
population sizes. I will quantify and trend Mycobacterium tuberculosis (Mtb) abundance at individual, facility,
and community levels. Additionally, I will analyze municipal wastewater samples from high TB-risk areas in the
US to evaluate Mtb burden in communities and examine the potential of genomic surveillance through
wastewater. My central hypothesis posits that Mtb nucleic acids in wastewater correlate with active TB disease
and can be used to infer population-level TB burden and circulating Mtb strains. The specific aims of this
research are: (1) to assess Mtb nucleic acid shedding in individuals with TB disease to inform interpretation of
wastewater concentrations; (2) to evaluate whether molecular testing of wastewater can differentiate between
congregate settings with varying TB incidence; and (3) to explore whole genome sequencing of Mtb through
communal wastewater in relation to clinical surveillance data. This research plan thus forms the basis of a 5-
year career development plan that will enhance my expertise in monitoring and detection of infectious disease,
geospatial analysis, and phylogenetics and provide the foundation necessary to become an independent
researcher in infectious diseases epidemiology and surveillance. Results from this proposed study have
immediate implications for enhancing TB case surveillance and monitoring of transmission in high TB-burden
settings locally and nationally, with a goal of identifying scalable approaches to mitigate the spread of TB and
protect the health of those most at risk and their communities worldwide.document fetched 2026-09-27 02:45