Application of wastewater and environmental surveillance for pathogenic agents during the 2024 National Football League (NFL) Draft in Detroit, Michigan (USA)

Abstract Mass gatherings pose a concern for public health because they are associated with dense crowds, increased social interaction, and travel, all of which can facilitate the rapid transmission of infectious diseases. Wastewater and environmental surveillance (WES) were used for pathogen monitoring during the 2024 NFL Annual Player Selection Meeting (the ‘Draft’) in Detroit, MI, an event that drew an estimated 775,000 attendees. Wastewater and environmental samples were queried for respiratory viruses and clinically relevant ARGs. WES did not detect an increase in the concentration of monitored respiratory viruses (SARS-CoV-2, IAV, IBV, and RSV) associated with the 2024 NFL Draft. In contrast, WES detected a transient increase in carbapenemase targets in wastewater, primarily driven by a fourfold increase in bla OXA-48 . Resistome structure in wastewater was dominated by sampling site characteristics rather than changes associated with the event. The Draft weekend coincided with rainfall-driven combined sewer overflow (CSO), potentially allowing the dissemination of antimicrobial resistance genes (ARGs) to the environment. In surface waters receiving wastewater effluent, an increase in detection frequency and normalized concentrations for multiple ARGs were observed following the Draft. WES provided an overview of pathogen prevalence before, during, and after a large-scale gathering, showing how it can warn of emerging health risks in near real time.