Does plastic waste present an infection hazard? Current evidence, surveillance challenges and research priorities.

Unmanaged plastic waste is widespread in settings with limited waste collection, yet its contribution to infectious disease risk remains poorly understood. In this review, we synthesise current evidence on the human health implications of plastic waste, with a specific focus on environmentally persistent bacteria that are transmitted to humans through the faecal oral route. We examine studies documenting microbial colonisation of plastic surfaces, including pathogenic and antimicrobial-resistant bacteria, and assess how well existing human and environmental surveillance systems capture these risks. We also review recent developments in remote sensing for detecting waste accumulation and evaluate spatial and statistical approaches that could link mapped waste to human exposure or infection data. Drawing on this synthesis, we identify major gaps that limit assessment of plastic-associated disease risk and outline key research priorities: improving methods for mapping waste using remotely sensed imagery, characterising spatial and temporal patterns of waste accumulation, and developing exposure metrics that incorporate environmental transport pathways. This review provides a foundation for advancing One Health research on plastic waste and its potential role in disease transmission.