"A Market-Based Sentinel Surveillance for an Early Detection of Viral Outbreaks"

Mexico has experienced recurrent viral epidemics of substantial intensity, including hyperendemic dengue, COVID-19, and recent reports of avian influenza A (H5N1) infections in birds, which pose an ongoing risk of zoonotic transmission. Mexico was also the location for the earliest detection of the pdmH1N1 virus during the 2009 influenza A pandemic. Under a One Health framework, markets represent a unique opportunity for low-cost virus monitoring at the human-animal interface. Under the hypothesis that these represent sentinel sites for an early virus detection, we implemented a pilot surveillance program at the central market of Merida city, Yucatan, Mexico, considered a regional hotspot for multiple and recent viral outbreaks. Longitudinal sampling was carried out over 11 months at 1-to-6-week intervals from April 2022 to February 2023. We used multi-type surveillance in mosquitoes, live poultry, and wastewater. All samples were screened using RT-qPCR. Positive samples for DENV, SARS-CoV-2 and avian influenza A were further sequenced and analysed under a phylogenetic and epidemiological approach. Through our entomological surveillance, we report the earliest detection of DENV-3 III-B3.2 (genotype III American II lineage, considered a major public health concern in Latin America) in Mexico, overlapping with the resurgence of DENV-3 as the predominant serotype driving the 2023 national epidemic, which showed an increased severity. Through wastewater surveillance, we consistently detect SARS-CoV-2 RNA in wastewater samples, coinciding with the two infection waves officially recorded at a city and state level. Finally, cloacal swabs taken from two juvenile birds at the market suggest that avian influenza A viruses circulated in live poultry sold at the market. These findings show that our market-based surveillance framework is effective for an early detection and monitoring of pathogenic viruses in urban settings, and could complement official epidemiological surveillance in low- and middle-income countries to strengthen early-outbreak warning systems.