Introduction

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Background
There is an increasing interest for monitoring the occurrence of antimicrobial resistance in non-clinical reservoirs. It is virtually impossible to obtain samples from healthy humans and there can be ethical problems with sensitivity of data collected from individuals. Thus, sewage has been suggested as an alternative to obtain population-wide samples.

Purpose
To collect representative sewage samples from cities around the world and analyze these for the occurrence of pathogens, antimicrobial resistance genes and other hazards, using, amongst others, metagenomic analysis.

Timeline
The current Global Sewage Surveillance project is a six year-project, running in the years 2017-2022. During these six years, sampling for point prevalence studies will be set-up four times in the early phase of the project period. The sampling months are: June and November 2017, and further June 2018, and November 2018.
The June 2017 sampling has been completed with 88 participating countries which sampled around 180 sites, in November 2017 90+ countries participated and we hope to include even more in June and November 2018.

Approach
Sampling: From each city, a representative sewage sample of 1 Liter should be collected from the city’s main sewage pipe prior to inlet to the treatment plant, from open sewage or from pipes leading out to rivers, sea etc.
Storage of samples: The samples must be stored at -80 degrees Celsius and sent to DTU Food, Denmark, for analysis after agreement with DTU Food.

Funding possibilities related to sample collection
As organizers of this sampling we offer to provide sample containers and packaging material. In addition, we cover all shipping expenses incl. custom fees. Additional funding is not available related to the sample collection or potential additional analysis at the participant institute.

Contact
For further details, please contact Rene S. Hendriksen (rshe@food.dtu.dk) or Jette Kjeldgaard (jetk@food.dtu.dk)

Note
An asterisk (*) indicates a question that requires an answer.

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