Public Health Weekly Report 2025; 18(1): 33-43
Published online November 29, 2024
https://doi.org/10.56786/PHWR.2025.18.1.3
© The Korea Disease Control and Prevention Agency
Dong-Ik Lee *, Seung-Hyuk Kim
, Ok-Soo Kim
Division of Quarantine Policy, Department of Infectious Disease Emergency Preparedness and Response, Korea Disease Control and Prevention Agency, Cheongju, Korea
*Corresponding author: Dong-Ik Lee, Tel: +82-43-719-9202, E-mail: ik0131@korea.kr
This is an Open Access journal distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted distribution, and reproduction in any medium, provided the original work is properly cited.
As the global coronavirus disease 2019 pandemic unfolded, many countries, including the United States and those in Europe, introduced wastewater-based infectious disease surveillance systems to monitor infectious disease outbreak trends and proactively respond to emerging threats. These systems have become integral components of national infectious disease surveillance policies. In 2023, the Korea Disease Control and Prevention Agency (KDCA) established the foundation for a pilot project of the Airport-Port Wastewater-based Infectious Disease Surveillance. In 2024, this initiative was launched, targeting airports, ports, and transportation vehicles (aircraft and ships) within the quarantine areas of 13 nationwide quarantine stations. In the future, the KDCA aims to collaborate with international wastewater surveillance consortia, domestic agencies, and related ministries to expand the scope of airport and port wastewater monitoring systems. Additionally, efforts will focus on enhancing laboratory techniques to develop a robust surveillance system capable of addressing national infectious disease crises.
Key words Wastewater-based epidemiological monitoring; Sewage surveillance; Wastewater surveillance; Wastewater-based epidemiology; Wastewater-based surveillance
In response to the coronavirus disease 2019 pandemic, many countries have adopted and expanded wastewater-based surveillance as a supplementary tool to clinical surveillance.
The Korea Disease Control and Prevention Agency is implementing airport and port wastewater-based infectious disease surveillance as an auxiliary measure to strengthen quarantine processes for international arrivals.
The wastewater-based surveillance project aims to analyze trends in the introduction of infectious diseases from overseas. Its success relies on establishing cooperative systems with relevant organizations and engaging in close information exchanges with international partners.
The global coronavirus disease 2019 (COVID-19) pandemic has led to numerous infections and fatalities, which prompted the initiation of wastewater-based infectious disease surveillance in the United States, Europe, and other countries. This surveillance strategy aims to preemptively detect and respond to trends in infectious disease outbreaks through the analysis of wastewater samples [1,2].
In the Republic of Korea (ROK), the KOrea WAstewater Surveillance (KOWAS) project, overseen by the Division of High-Risk Pathogens at the Korea Disease Control and Prevention Agency (KDCA), has been operational since 2021. Its findings are regularly published on the KDCA website [3].
Alongside the existing measures for quarantining incoming travelers, which focus on responding to severe cases of known symptomatic infectious diseases at airports and seaports—a common entry point for international travelers—the Division of Quarantine Policy of KDCA launched the Airport-Port Wastewater-based Infectious Disease Surveillance Pilot Program. This program operated at eight quarantine stations from July to November 2023 and expanded to include all 13 National Quarantine Stations starting in 2024 [4].
This article presents the progress of the Airport-Port Wastewater-based Infectious Disease Surveillance Pilot Program and explores potential improvements for future implementation.
In ROK, 13 National Quarantine Stations carry out epidemiological surveillance for infectious diseases in international arrivals at airports and ports. This includes fever detection using thermal imaging cameras and the collection of symptom data through individualized Q-CODE or health status questionnaires. When an arrival is suspected of harboring a quarantinable infectious disease, they are subjected to testing and isolation.
Such quarantine measures, however, primarily target symptomatic individuals and thus struggle to detect infectious diseases during their incubation period at the point of entry.
In response, countries like the United States and Europe have begun to supplement their surveillance efforts by collecting and testing wastewater from airport sewage systems and aircraft. This approach involves pathogen testing and genomic analysis of the wastewater samples, aiding in the development of national public health policies.
Embracing a goal to foster a “healthy society safe from overseas diseases,” the KDCA has integrated the Airport-Port Wastewater-based Infectious Disease Surveillance System into its 1st Quarantine Management Basic Plan for 2023–2027. This plan includes four major strategies and 15 sub-strategies [5]. Inspired by international wastewater surveillance initiatives and local Korean efforts, the KDCA aims to rapidly detect and respond to the introduction of infectious diseases via airports and ports (Figure 1).
The Airport-Port Wastewater-based Infectious Disease Surveillance System began with a pilot program at eight quarantine stations from July to November 2023, and the regular program was officially launched in 2024 after addressing initial shortcomings and securing the necessary budget.
The scope of the official program has since been expanded to include all 13 National Quarantine Stations, covering airports and ports, including international airports and international passenger terminals (Table 1).
Quarantine | Points and targets |
---|---|
Incheon airport | |
Main office | Airport wastewater, aircraft wastewater |
Gimpo airport branch | Airport wastewater, aircraft wastewater |
Incheon | International passenger ship terminal wastewater, ship wastewater |
Donghae (Sokcho branch) | Airport wastewater |
International passenger ship terminal wastewater | |
Gunsan | International passenger ship terminal wastewater, ship wastewater |
Pyeongtaek | |
Main office | International passenger ship terminal wastewater |
Cheongju airport branch | Airport wastewater, aircraft wastewater |
Mokpo | |
Main office | Port wastewater |
Muan airport branch | Airport wastewater, aircraft wastewater |
Yeosu | Port wastewater |
Jeju | |
Main office | International passenger ship terminal wastewater |
Jeju airport branch | Airport wastewater, aircraft wastewater |
Ulsan | Port wastewater |
Pohang (Daegu airport branch) | Airport wastewater, aircraft wastewater |
Busan | International passenger ship terminal wastewater, ship wastewater |
Gimhae airport | Airport wastewater, aircraft wastewater |
Masan | Port wastewater |
In terms of process, quarantine officers at these stations collect wastewater from airports and ports, as well as from aircraft and ships, and transport it to the Regional Centers for Disease Control and Prevention (RCDC). Here, laboratory tests are conducted on the samples.
Initially, the screening covered six pathogens: dengue virus, chikungunya, Zika virus, mpox, COVID-19, and influenza. Since August 2024, cholera and yellow fever have been added to the list.
Since September 2024, positive samples for COVID-19, influenza, and mpox have been forwarded to the relevant divisions within the KDCA for genetic analysis, specifically the Division of Emerging Infectious Diseases and the Division of High-Risk Pathogens.
This data is intended to help identify trends in infectious diseases, such as genome-based surveillance for the overseas introduction of new variants when pathogens are detected. Particularly when quarantinable infectious diseases such as cholera, yellow fever virus, dengue virus, chikungunya, and mpox are identified, this information will facilitate quarantine measures at airports and seaports and enhance the promotion of infectious disease prevention among international travelers (Figure 2).
Furthermore, wastewater surveillance is also employed to enhance specific pathogen monitoring. For instance, following the World Health Organization’s declaration of a Public Health Emergency of International Concern for mpox in August 2024, intensive surveillance was targeted at aircraft arriving at Incheon International Airport from major transit countries in the Middle East, Europe, and Ethiopia, which are linked to Clade I mpox occurrences in Africa. This targeted surveillance, which began on August 19, 2024, includes inspections of aircraft sewage.
Detected cases of mpox undergo gene analysis, and this process is used to enable a preemptive response to the introduction of mpox through airport-port wastewater-based surveillance.
During the first half of 2024 (January 1 to August 31), the pathogen detection rate across all 1,042 samples was 67.7%, with pathogens detected in 706 samples. COVID-19 showed the highest detection rate at 84.2% (688 cases), followed by influenza A at 10.8% (88 cases) and influenza B at 5.0% (41 cases). During this period, no pathogens of quarantinable infectious diseases were detected. While COVID-19 continued to be detected, reflecting strains circulating both in ROK and internationally, no other quarantinable infectious diseases were identified (Figure 3).
In other countries (United States, Europe, etc.), airport and aircraft wastewater surveillance is utilized to gather infectious disease-related research data and to track trends in infectious diseases, such as monitoring emerging variants.
Drawing on these international examples, ROK, since September 2024, has also been performing additional genetic analysis on wastewater where pathogens (mpox, COVID-19, influenza) have been detected. This is achieved through collaboration among various departments within the KDCA, including the Division of Quarantine Policy, the Division of Emerging Infectious Diseases, the Division of High-Risk Pathogens, and the Department of Diagnosis at the RCDC. The goal is to use this data to monitor trends in infectious diseases, such as genome-based surveillance of the overseas introduction of emerging variants.
Recognizing that foreign countries, like the Centers for Disease Control and Prevention in the United States, operate a complementary surveillance system—the traveler-based genomic surveillance program (TGS) [6]—that includes clinical tests (such as voluntary respiratory tests for international travelers) alongside environmental testing (airport wastewater and aircraft sewage tests), ROK is currently considering integrating airport-port wastewater-based surveillance with clinical testing. This integration aims to create a synergistic surveillance system that enhances disease tracking and response capabilities.
In response to the failure to detect quarantinable infectious diseases targeted by the airport-port wastewater-based surveillance, plans are underway to enhance the detection rate of pathogens. This includes changing the collection points of wastewater at the airport and port, adjusting the target aircraft for sample collection, and improving test sensitivity in consultation with the Department of Laboratory Diagnosis and analysis.
Additionally, the KDCA is aligning with international trends by joining the Global Consortium for Wastewater and Environmental Surveillance for Public Health, which was initiated in March 2024 under the leadership of the European Union. KDCA plans to establish a complementary surveillance system that integrates airport-port wastewater-based surveillance with KOWAS.
Through these efforts, KDCA aims to further develop the Airport-Port Wastewater-based Infectious Disease Surveillance Program by enhancing testing techniques and expanding the range of pathogens monitored. These improvements are designed to lay the groundwork for rapid detection and effective response to the introduction of infectious diseases from abroad.
Ethics Statement: Not applicable.
Funding Source: None.
Acknowledgments: None.
Conflict of Interest: The authors have no conflicts of interest to declare.
Author Contributions: Conceptualization: DIL. Data curation: DIL. Investigation: DIL. Visualization: DIL. Writing – original draft: DIL. Methodology: SHK, OSK. Writing – review & editing: SHK, OSK.
Public Health Weekly Report 2025; 18(1): 33-43
Published online January 2, 2025 https://doi.org/10.56786/PHWR.2025.18.1.3
Copyright © The Korea Disease Control and Prevention Agency.
Dong-Ik Lee *, Seung-Hyuk Kim
, Ok-Soo Kim
Division of Quarantine Policy, Department of Infectious Disease Emergency Preparedness and Response, Korea Disease Control and Prevention Agency, Cheongju, Korea
Correspondence to:*Corresponding author: Dong-Ik Lee, Tel: +82-43-719-9202, E-mail: ik0131@korea.kr
This is an Open Access journal distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted distribution, and reproduction in any medium, provided the original work is properly cited.
As the global coronavirus disease 2019 pandemic unfolded, many countries, including the United States and those in Europe, introduced wastewater-based infectious disease surveillance systems to monitor infectious disease outbreak trends and proactively respond to emerging threats. These systems have become integral components of national infectious disease surveillance policies. In 2023, the Korea Disease Control and Prevention Agency (KDCA) established the foundation for a pilot project of the Airport-Port Wastewater-based Infectious Disease Surveillance. In 2024, this initiative was launched, targeting airports, ports, and transportation vehicles (aircraft and ships) within the quarantine areas of 13 nationwide quarantine stations. In the future, the KDCA aims to collaborate with international wastewater surveillance consortia, domestic agencies, and related ministries to expand the scope of airport and port wastewater monitoring systems. Additionally, efforts will focus on enhancing laboratory techniques to develop a robust surveillance system capable of addressing national infectious disease crises.
Keywords: Wastewater-based epidemiological monitoring, Sewage surveillance, Wastewater surveillance, Wastewater-based epidemiology, Wastewater-based surveillance
In response to the coronavirus disease 2019 pandemic, many countries have adopted and expanded wastewater-based surveillance as a supplementary tool to clinical surveillance.
The Korea Disease Control and Prevention Agency is implementing airport and port wastewater-based infectious disease surveillance as an auxiliary measure to strengthen quarantine processes for international arrivals.
The wastewater-based surveillance project aims to analyze trends in the introduction of infectious diseases from overseas. Its success relies on establishing cooperative systems with relevant organizations and engaging in close information exchanges with international partners.
The global coronavirus disease 2019 (COVID-19) pandemic has led to numerous infections and fatalities, which prompted the initiation of wastewater-based infectious disease surveillance in the United States, Europe, and other countries. This surveillance strategy aims to preemptively detect and respond to trends in infectious disease outbreaks through the analysis of wastewater samples [1,2].
In the Republic of Korea (ROK), the KOrea WAstewater Surveillance (KOWAS) project, overseen by the Division of High-Risk Pathogens at the Korea Disease Control and Prevention Agency (KDCA), has been operational since 2021. Its findings are regularly published on the KDCA website [3].
Alongside the existing measures for quarantining incoming travelers, which focus on responding to severe cases of known symptomatic infectious diseases at airports and seaports—a common entry point for international travelers—the Division of Quarantine Policy of KDCA launched the Airport-Port Wastewater-based Infectious Disease Surveillance Pilot Program. This program operated at eight quarantine stations from July to November 2023 and expanded to include all 13 National Quarantine Stations starting in 2024 [4].
This article presents the progress of the Airport-Port Wastewater-based Infectious Disease Surveillance Pilot Program and explores potential improvements for future implementation.
In ROK, 13 National Quarantine Stations carry out epidemiological surveillance for infectious diseases in international arrivals at airports and ports. This includes fever detection using thermal imaging cameras and the collection of symptom data through individualized Q-CODE or health status questionnaires. When an arrival is suspected of harboring a quarantinable infectious disease, they are subjected to testing and isolation.
Such quarantine measures, however, primarily target symptomatic individuals and thus struggle to detect infectious diseases during their incubation period at the point of entry.
In response, countries like the United States and Europe have begun to supplement their surveillance efforts by collecting and testing wastewater from airport sewage systems and aircraft. This approach involves pathogen testing and genomic analysis of the wastewater samples, aiding in the development of national public health policies.
Embracing a goal to foster a “healthy society safe from overseas diseases,” the KDCA has integrated the Airport-Port Wastewater-based Infectious Disease Surveillance System into its 1st Quarantine Management Basic Plan for 2023–2027. This plan includes four major strategies and 15 sub-strategies [5]. Inspired by international wastewater surveillance initiatives and local Korean efforts, the KDCA aims to rapidly detect and respond to the introduction of infectious diseases via airports and ports (Figure 1).
The Airport-Port Wastewater-based Infectious Disease Surveillance System began with a pilot program at eight quarantine stations from July to November 2023, and the regular program was officially launched in 2024 after addressing initial shortcomings and securing the necessary budget.
The scope of the official program has since been expanded to include all 13 National Quarantine Stations, covering airports and ports, including international airports and international passenger terminals (Table 1).
Quarantine | Points and targets |
---|---|
Incheon airport | |
Main office | Airport wastewater, aircraft wastewater |
Gimpo airport branch | Airport wastewater, aircraft wastewater |
Incheon | International passenger ship terminal wastewater, ship wastewater |
Donghae (Sokcho branch) | Airport wastewater |
International passenger ship terminal wastewater | |
Gunsan | International passenger ship terminal wastewater, ship wastewater |
Pyeongtaek | |
Main office | International passenger ship terminal wastewater |
Cheongju airport branch | Airport wastewater, aircraft wastewater |
Mokpo | |
Main office | Port wastewater |
Muan airport branch | Airport wastewater, aircraft wastewater |
Yeosu | Port wastewater |
Jeju | |
Main office | International passenger ship terminal wastewater |
Jeju airport branch | Airport wastewater, aircraft wastewater |
Ulsan | Port wastewater |
Pohang (Daegu airport branch) | Airport wastewater, aircraft wastewater |
Busan | International passenger ship terminal wastewater, ship wastewater |
Gimhae airport | Airport wastewater, aircraft wastewater |
Masan | Port wastewater |
In terms of process, quarantine officers at these stations collect wastewater from airports and ports, as well as from aircraft and ships, and transport it to the Regional Centers for Disease Control and Prevention (RCDC). Here, laboratory tests are conducted on the samples.
Initially, the screening covered six pathogens: dengue virus, chikungunya, Zika virus, mpox, COVID-19, and influenza. Since August 2024, cholera and yellow fever have been added to the list.
Since September 2024, positive samples for COVID-19, influenza, and mpox have been forwarded to the relevant divisions within the KDCA for genetic analysis, specifically the Division of Emerging Infectious Diseases and the Division of High-Risk Pathogens.
This data is intended to help identify trends in infectious diseases, such as genome-based surveillance for the overseas introduction of new variants when pathogens are detected. Particularly when quarantinable infectious diseases such as cholera, yellow fever virus, dengue virus, chikungunya, and mpox are identified, this information will facilitate quarantine measures at airports and seaports and enhance the promotion of infectious disease prevention among international travelers (Figure 2).
Furthermore, wastewater surveillance is also employed to enhance specific pathogen monitoring. For instance, following the World Health Organization’s declaration of a Public Health Emergency of International Concern for mpox in August 2024, intensive surveillance was targeted at aircraft arriving at Incheon International Airport from major transit countries in the Middle East, Europe, and Ethiopia, which are linked to Clade I mpox occurrences in Africa. This targeted surveillance, which began on August 19, 2024, includes inspections of aircraft sewage.
Detected cases of mpox undergo gene analysis, and this process is used to enable a preemptive response to the introduction of mpox through airport-port wastewater-based surveillance.
During the first half of 2024 (January 1 to August 31), the pathogen detection rate across all 1,042 samples was 67.7%, with pathogens detected in 706 samples. COVID-19 showed the highest detection rate at 84.2% (688 cases), followed by influenza A at 10.8% (88 cases) and influenza B at 5.0% (41 cases). During this period, no pathogens of quarantinable infectious diseases were detected. While COVID-19 continued to be detected, reflecting strains circulating both in ROK and internationally, no other quarantinable infectious diseases were identified (Figure 3).
In other countries (United States, Europe, etc.), airport and aircraft wastewater surveillance is utilized to gather infectious disease-related research data and to track trends in infectious diseases, such as monitoring emerging variants.
Drawing on these international examples, ROK, since September 2024, has also been performing additional genetic analysis on wastewater where pathogens (mpox, COVID-19, influenza) have been detected. This is achieved through collaboration among various departments within the KDCA, including the Division of Quarantine Policy, the Division of Emerging Infectious Diseases, the Division of High-Risk Pathogens, and the Department of Diagnosis at the RCDC. The goal is to use this data to monitor trends in infectious diseases, such as genome-based surveillance of the overseas introduction of emerging variants.
Recognizing that foreign countries, like the Centers for Disease Control and Prevention in the United States, operate a complementary surveillance system—the traveler-based genomic surveillance program (TGS) [6]—that includes clinical tests (such as voluntary respiratory tests for international travelers) alongside environmental testing (airport wastewater and aircraft sewage tests), ROK is currently considering integrating airport-port wastewater-based surveillance with clinical testing. This integration aims to create a synergistic surveillance system that enhances disease tracking and response capabilities.
In response to the failure to detect quarantinable infectious diseases targeted by the airport-port wastewater-based surveillance, plans are underway to enhance the detection rate of pathogens. This includes changing the collection points of wastewater at the airport and port, adjusting the target aircraft for sample collection, and improving test sensitivity in consultation with the Department of Laboratory Diagnosis and analysis.
Additionally, the KDCA is aligning with international trends by joining the Global Consortium for Wastewater and Environmental Surveillance for Public Health, which was initiated in March 2024 under the leadership of the European Union. KDCA plans to establish a complementary surveillance system that integrates airport-port wastewater-based surveillance with KOWAS.
Through these efforts, KDCA aims to further develop the Airport-Port Wastewater-based Infectious Disease Surveillance Program by enhancing testing techniques and expanding the range of pathogens monitored. These improvements are designed to lay the groundwork for rapid detection and effective response to the introduction of infectious diseases from abroad.
Ethics Statement: Not applicable.
Funding Source: None.
Acknowledgments: None.
Conflict of Interest: The authors have no conflicts of interest to declare.
Author Contributions: Conceptualization: DIL. Data curation: DIL. Investigation: DIL. Visualization: DIL. Writing – original draft: DIL. Methodology: SHK, OSK. Writing – review & editing: SHK, OSK.
Quarantine | Points and targets |
---|---|
Incheon airport | |
Main office | Airport wastewater, aircraft wastewater |
Gimpo airport branch | Airport wastewater, aircraft wastewater |
Incheon | International passenger ship terminal wastewater, ship wastewater |
Donghae (Sokcho branch) | Airport wastewater |
International passenger ship terminal wastewater | |
Gunsan | International passenger ship terminal wastewater, ship wastewater |
Pyeongtaek | |
Main office | International passenger ship terminal wastewater |
Cheongju airport branch | Airport wastewater, aircraft wastewater |
Mokpo | |
Main office | Port wastewater |
Muan airport branch | Airport wastewater, aircraft wastewater |
Yeosu | Port wastewater |
Jeju | |
Main office | International passenger ship terminal wastewater |
Jeju airport branch | Airport wastewater, aircraft wastewater |
Ulsan | Port wastewater |
Pohang (Daegu airport branch) | Airport wastewater, aircraft wastewater |
Busan | International passenger ship terminal wastewater, ship wastewater |
Gimhae airport | Airport wastewater, aircraft wastewater |
Masan | Port wastewater |
Jeong Hyun Lee, Hye Jin Park, Hwajung Yi, Yoon-Seok Chung*
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Public Health Weekly Report 2023; 16(14): 424-438 https://doi.org/10.56786/PHWR.2023.16.14.2