Wastewater-based epidemiology in low Human Development Index states: bias in consumption monitoring of illicit drugs

Assessing changes in nicotine consumption over two years in a population of Hanoi by wastewater analysis with benchmarking biomarkers

Monitoring the actual change in consumption of nicotine (a proxy for smoking) in the population is essential for formulating tobacco control policies. In recent years, wastewater-based epidemiology (WBE) has been applied as an alternative method to estimate changes in consumption of tobacco and other substances in different communities around the world, with high potential to be used in resource-scarce settings. This study aimed to conduct a WBE analysis in Hanoi, Vietnam, a lower-middle-income-country setting known for high smoking prevalence. Wastewater samples were collected at two sites along a sewage canal in Hanoi during three periods: Period 1 (September 2018), Period 2 (December 2018-January 2019), and Period 3 (December 2019-January 2020). Concentrations of cotinine, 3-hydroxycotinine, and nicotine ranged from 0.73 μg/L to 3.83 μg/L, from 1.09 μg/L to 5.07 μg/L, and from 0.97 μg/L to 9.90 μg/L, respectively. The average mass load of cotinine estimated for our samples was 0.45 ± 0.09 mg/day/person, which corresponds to an estimated daily nicotine consumption of 1.28 ± 0.25 mg/day/person. No weekly trend was detected over the three monitoring periods. We found the amount of nicotine consumption in Period 1 to be significantly lower than in Period 2 and Period 3. Our WBE estimates of smoking prevalence were slightly lower than the survey data. The analysis of benchmarking biomarkers confirmed that cotinine was stable in the samples similar to acesulfame, while paracetamol degraded along the sewer canal. Further refinement of the WBE approach may be required to improve the accuracy of analyzing tobacco consumption in the poor sewage infrastructure setting of Vietnam.

Prevalence of illicit drug consumption in a population of Hanoi: an estimation using wastewater-based epidemiology

Illicit drug use is a serious issue in Vietnam, but information about their prevalence is scarce, mainly based on seizure data. Wastewater-based epidemiology (WBE) is an alternative tool for obtaining such information, especially when stigma related to drug use can hinder survey approaches. The study aimed to apply WBE to assess the prevalence of use of a range of illicit drugs in an urban population of Vietnam. A total of 184 wastewater samples were collected at two different sites along a sewage canal, receiving sewage from over 400,000 people in Hanoi, Vietnam, in three different periods between 2018 and 2020. Illicit drugs and their metabolites were measured by direct injection using liquid chromatography-tandem mass spectrometry. The results were back-estimated, normalised to per capita daily consumption for assessement of consumption patterns and trends. Most drugs were detected in all the samples except cocaine, benzoylecgonine, amphetamine indicating a low prevalence of cocaine and amphetamine use. The estimated consumption level of methamphetamine was varied from 119.5 to 553.5 mg/d/1000 pp. The market of illicit drugs in Vietnam has changed from opiates to amphetamine-type simulants, and methamphetamine has replaced heroin as the No.1 drug, its use can be as much as 3 times more than heroin use. Moreover, we observed the considerable and potentially increasing level of ketamine consumption in Hanoi. No statistical difference was found in daily consumption per capita among days of the week for any drugs, both legal (codeine, methadone) and illegal (methamphetamine, MDMA, ketamine and heroin), suggesting the drugs were consumed mainly by regular users. This study provides important information related the illicit drug consumption in Vietnam, which will help to formulate appropriate drug control policies in this country.

Wastewater-based epidemiology for illicit drugs: A critical review on global data

Illicit drug use is complex, hidden and often highly stigmatized behaviour, which brings a vast challenge for drug surveillance systems. Drug consumption can be estimated by measuring human excretion products in untreated wastewater, known as wastewater-based epidemiology (WBE). Over the last decade, the application of wastewater-based epidemiology to monitor illicit drug loads increased and WBE is currently applied on a global scale. Studies from over the globe are evaluated with regard to their sampling method, analytical accuracy and consumption calculation, aiming to further reduce relevant uncertainties in order to make reliable comparisons on a global level. Only a limited number is identified as high-quality studies, so further standardization of the WBE approach for illicit drugs is desired especially with regard to the sampling methodology. Only a fraction of the reviewed papers explicitly reports uncertainty ranges for their consumption data. Studies which had the highest reliability are recently published, indicating an improvement in reporting WBE data. Until now, WBE has not been used in large parts of Africa, nor in the Middle East and Russia. An overview of consumption data across the continents on commonly studied drugs (cocaine, MDMA, amphetamine and methamphetamine) is provided. Overall, high consumption rates are confirmed in the US, especially for cocaine and methamphetamine, while relatively low illicit drug consumption is reported in Asia.

Wastewater-Based Epidemiology for Cost-Effective Mass Surveillance of COVID-19 in Low- and Middle-Income Countries: Challenges and Opportunities

Wastewater-based epidemiology (WBE) is an approach that can be used to estimate COVID-19 prevalence in the population by detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater. As the WBE approach uses pooled samples from the study population, it is an inexpensive and non-invasive mass surveillance method compared to individual testing. Thus, it offers a good complement in low- and middle-income countries (LMICs) facing high costs of testing or social stigmatization, and it has a huge potential to monitor SARS-CoV-2 and its variants to curb the global COVID-19 pandemic. The aim of this review is to systematize the current evidence about the application of the WBE approach in mass surveillance of COVID-19 infection in LMICs, as well as its future potential. Among other parameters, population size contributing the fecal input to wastewater is an important parameter for COVID-19 prevalence estimation. It is easier to back-calculate COVID-19 prevalence in the community with centralized wastewater systems, because there can be more accurate estimates about the size of contributing population in the catchment. However, centralized wastewater management systems are often of low quality (or even non-existent) in LMICs, which raises a major concern about the ability to implement the WBE approach. However, it is possible to mobilize the WBE approach, if large areas are divided into sub-areas, corresponding to the existing wastewater management systems. In addition, a strong coordination between stakeholders is required for estimating population size respective to wastewater management systems. Nevertheless, further international efforts should be leveraged to strengthen the sanitation infrastructures in LMICs, using the lessons gathered from the current COVID-19 pandemic to be prepared for future pandemics.

Interpol review of controlled substances 2016-2019

This review paper covers the forensic-relevant literature in controlled substances from 2016 to 2019 as a part of the 19th Interpol International Forensic Science Managers Symposium. The review papers are also available at the Interpol website at: https://www.interpol.int/content/download/14458/file/Interpol%20Review%20Papers%202019.pdf.

Wastewater-based epidemiology approach to assess population exposure to pesticides: a review of a pesticide pharmacokinetic dataset

Wastewater-based epidemiology is an innovative approach to estimate a population's intentional and unintentional consumption of chemicals based on biomarker assays found in wastewater. This method can provide real-time objective information on the xenobiotics to which a population is directly or indirectly exposed. This approach has already been used to assess the population exposure to four classes of pesticides: organochlorines (chlordecone), triazines, organophosphates, and pyrethroids. This review aims to obtain the data (excretion rates) and characteristics (pesticide and metabolites stability, including in-sewer one) for other pesticides to broaden the scope of this new method. Excretion rates and stability descriptions for 14 pesticides, namely 2,4-D, aldrin, carbaryl, chlorobenzilate, dieldrin, diquat, ethion, glufosinate, glyphosate, folpet, malathion, parathion, penconazole, and tebuconazole, will be discussed in a practical framework.