Transformation of Illicit Drugs and Pharmaceuticals in Sewer Sediments

The fate of pharmaceuticals and personal care products (PPCPs) in sewer sediments:Adsorption triggering resistance gene proliferation

In recent years, large quantities of pharmaceuticals and personal care products (PPCPs) have been discharged into sewers, while the mechanisms of PPCPs enrichment in sewer sediments have rarely been revealed. In this study, three PPCPs (tetracycline, sulfamethoxazole, and triclocarban) were added consecutively over a 90-day experimental period to reveal the mechanisms of PPCPs enrichment and the transmission of resistance genes in sewer sediments. The results showed that tetracycline (TC) and triclocarban (TCC) have higher adsorption concentration in sediments compared to sulfamethoxazole (SMX). The absolute abundance of Tets and suls genes increased in sediments under PPCPs pressure. The increase in secretion of extracellular polymeric substances (EPS) and the loosening of the structure exposed a large number of hydrophobic functional groups, which promoted the adsorption of PPCPs. The absolute abundance of antibiotic resistance genes (ARGs), EPS and the content of PPCPs in sediments exhibited significant correlations. The enrichment of PPCPs in sediments was attributed to the accumulation of EPS, which led to the proliferation of ARGs. These findings contributed to further understanding of the fate of PPCPs in sewer sediments and opened a new perspective for consideration of controlling the proliferation of resistance genes.

Deciphering carbon emissions in urban sewer networks: Bridging urban sewer networks with city-wide environmental dynamics

As urbanization accelerates, understanding and managing carbon emissions from urban sewer networks have become crucial for sustainable urban water cycles. This review examines the factors influencing greenhouse gas (GHG) emissions within urban sewage systems, analyzing the complex effects between water quality, hydrodynamics, and sewer infrastructure on GHG production and emission processes. It reveals significant spatiotemporal heterogeneity in GHG emissions, particularly under long-term scenarios where flow rates and temperatures exhibit strong impacts and correlations. Given the presence of fugitive and dissolved potential GHGs, standardized monitoring and accounting methods are deemed essential. Advanced modeling techniques emerge as crucial tools for large-scale carbon emission prediction and management. The review identifies that traditional definitions and computational frameworks for carbon emission boundaries fail to fully consider the inherent heterogeneity of sewers and the dynamic changes and impacts of multi-source pollution within the sewer system during the urban water cycle. This includes irregular fugitive emissions, the influence of stormwater systems, climate change, geographical features, sewer design, and the impacts of food waste and antibiotics. Key strategies for emission management are discussed, focusing on the need for careful consideration of approaches that might inadvertently increase global emissions, such as ventilation, chemical treatments, and water management practices. The review advocates for an overarching strategy that encompasses a holistic view of carbon emissions, stressing the importance of refined emission boundary definitions, novel accounting practices, and comprehensive management schemes in line with the water treatment sector's move towards carbon neutrality. It champions the adoption of interdisciplinary, technologically advanced solutions to mitigate pollution and reduce carbon emissions, emphasizing the importance of integrating cross-scale issues and other environmentally friendly measures in future research directions.

In-sewer stability assessment of 140 pharmaceuticals, personal care products, pesticides and their metabolites: Implications for wastewater-based epidemiology biomarker screening

The monitoring of pharmaceuticals, personal care products (PCPs), pesticides, and their metabolites through wastewater-based epidemiology (WBE) provides timely information on pharmaceutical consumption patterns, chronic disease treatment rates, antibiotic usage, and exposure to harmful chemicals. However, before applying them for quantitative WBE back-estimation, it is necessary to understand their stability in the sewer system to screen suitable WBE biomarkers thereby reducing research uncertainty. This study investigated the in-sewer stability of 140 typical pharmaceuticals, PCPs, pesticides, and their metabolites across 15 subcategories, using a series of laboratory sewer sediment and biofilm reactors. For the first time, stability results for 89 of these compounds were reported. Among the 140 target compounds, 61 biomarkers demonstrated high stability in all sewer reactors, while 41 biomarkers were significantly removed merely by sediment processes. For biomarkers exhibiting notable attenuation, the influence of sediment processes was generally more pronounced than biofilm, due to its stronger microbial activities and more pronounced diffusion or adsorption processes. Adsorption emerged as the predominant factor causing biomarker removal compared to biodegradation and diffusion. Significantly different organic carbon-water partitioning coefficient (Koc) and distribution coefficient at pH = 7 (logD) values were observed between highly stable and unstable biomarkers, with most hydrophobic substances (Koc > 100 or logD > 2) displaying instability. In light of these findings, we introduced a primary biomarker screening process to efficiently exclude inappropriate candidates, achieving a commendable 77 % accuracy. Overall, this study represents the first comprehensive report on the in-sewer stability of 89 pharmaceuticals, PCPs, pesticides, and their metabolites, and provided crucial reference points for understanding the intricate sewer sediment processes.

In-sewer stability of 31 human health biomarkers and suitability for wastewater-based epidemiology

Monitoring urinary markers of dietary, disease, and stress by wastewater-based epidemiology (WBE) is a promising tool to better understand population health and wellbeing. However, common urinary biomarkers are subject to degradation in sewer systems and their fates have to be assessed before they can be used in WBE. This study investigated the stability of 31 urinary biomarkers (12 food biomarkers, 8 vitamins, 9 oxidative stress biomarkers, and 1 histamine biomarker) in a laboratory sewer sediment reactor and evaluated their suitability for WBE, considering their detectability in real wastewater and in-sewer stability. These biomarkers showed various transformation patterns, among which 16 compounds had half-lives <2 h while other 15 compounds presented moderate to high stability (2 to >500 h). Thirteen biomarkers showed potential for WBE because of their consistently measurable concentrations in untreated wastewater and sufficient in-sewer stability. Eighteen biomarkers were unsuitable due to their rapid in-sewer degradation and/or undetectable concentration levels in untreated wastewater using previous methods. Transformation rates of these biomarkers showed generally weak relationships with molecular properties but relatively higher correlations with biological activities in sewers. Overall, this study determined in-sewer stability of 31 health-related biomarkers through laboratory experiments, providing new findings to WBE for population health assessment.

The role of microorganisms in the biotransformation of psychoactive substances and its forensic relevance: a critical interdisciplinary review

Microorganisms are widespread on the planet being able to adapt, persist, and grow in diverse environments, either rich in nutrient sources or under harsh conditions. The comprehension of the interaction between microorganisms and drugs is relevant for forensic toxicology and forensic chemistry, elucidating potential pathways of microbial metabolism and their implications. Considering the described scenario, this paper aims to provide a comprehensive and critical review of the state of the art of interactions amongst microorganisms and common drugs of abuse. Additionally, other drugs of forensic interest are briefly discussed. This paper outlines the importance of this area of investigation, covering the intersections between forensic microbiology, forensic chemistry, and forensic toxicology applied to drugs of abuse, and it also highlights research potentialities.

Key points

Microorganisms are widespread on the planet and grow in a myriad of environments.Microorganisms can often be found in matrices of forensic interest.Drugs can be metabolized or produced (e.g. ethanol) by microorganisms.

Stability and WBE biomarkers possibility of 17 antiviral drugs in sewage and gravity sewers

Wastewater-based epidemiology (WBE) is a promising technique for monitoring the rapidly increasing use of antiviral drugs during the COVID-19 pandemic. It is essential to evaluate the in-sewer stability of antiviral drugs in order to determine appropriate biomarkers. This study developed an analytical method for quantification of 17 typical antiviral drugs, and investigated the stability of target compounds in sewer through 4 laboratory-scale gravity sewer reactors. Nine antiviral drugs (lamivudine, acyclovir, amantadine, favipiravir, nevirapine, oseltamivir, ganciclovir, emtricitabine and telbivudine) were observed to be stable and recommended as appropriate biomarkers for WBE. As for the other 8 unstable drugs (abacavir, arbidol, ribavirin, zidovudine, ritonavir, lopinavir, remdesivir and efavirenz), their attenuation was driven by adsorption, biodegradation and diffusion. Moreover, reaction kinetics revealed that the effects of sediments and biofilms were regarded to be independent in gravity sewers, and the rate constants of removal by biofilms was directly proportional to the ratio of surface area against wastewater volume. The study highlighted the potential importance of flow velocity for compound stability, since an increased flow velocity significantly accelerated the removal of unstable biomarkers. In addition, a framework for graded evaluation of biomarker stability was proposed to provide reference for researchers to select suitable WBE biomarkers. Compared with current classification method, this framework considered the influences of residence time and different removal mechanisms, which additionally screened four antiviral drugs as viable WBE biomarkers. This is the first study to report the stability of antiviral drugs in gravity sewers.

Nitrogen-doped magnetic porous carbon material from low-cost anion-exchange resin as an efficient adsorbent for tetracyclines in water

In this work, nitrogen-doped magnetic porous carbon material (N-MPC) was prepared through the high-temperature calcination of low-cost [Fe(CN)₆]^3--loaded anion-exchange resin, which was experimentally demonstrated to have significant adsorption performance for tetracycline (TC) in water. The N-MPC adsorbent with a large specific surface area (781.1 m² g^-1) was able to maintain excellent performance in a wide pH range from 4 to 10 or in high ionic strength solution. The adsorption of TC on N-MPC was found to be more consistent with the pseudo-second-order model and Langmuir adsorption model, and the maximum adsorption capacity (q_{m, cal}) was calculated to be 603.4 mg g^-1. As a recoverable magnetic adsorbent, the N-MPC remained a TC removal rate higher than 70% after four adsorption cycles. The adsorption mechanism was speculated on the basis of characterizations, where pore filling, hydrogen bonding interaction, and π-π electron donor-acceptor (EDA) interaction were crucial adsorption mechanisms. A variety of antibiotics were selected for adsorption, and excellent performance was found especially for TCs, indicating that the N-MPC can be used for the efficient removal of TCs from water.

Biomarker selection strategies based on compound stability in wastewater-based epidemiology

The specific compositions of human excreta in sewage can be used as biomarkers to indicate the disease prevalence, health status, and lifestyle of the population living in the investigated catchment. It is important for guiding and evaluating public health policies as well as promoting human health development. Among several parameters of wastewater-based epidemiology (WBE), the decay of biomarkers during transportation in sewer and storage plays a crucial role in the back-calculation of population consumption. In this paper, we summarized the stability data of common biomarkers in storage at different temperatures and in-sewer transportation. Among them, cardiovascular drugs and antidiabetic drugs are very stable which can be used as biomarkers; most of the illicit drugs are stable except for cocaine, heroin, and tetrahydrocannabinol which could be substituted by their metabolites as biomarkers. There are some losses for part of antibiotics and antidepressants even in frozen storage. Rapid detection of contagious viruses is a new challenge for infectious disease control. With the deeper and broader study of biomarkers, it is expected that the reliable application of the WBE will be a useful addition to epidemiological studies.

A critical review of wastewater quality variation and in-sewer processes during conveyance in sewer systems

In-sewer physio-biochemical processes cause significant variations of wastewater quality during conveyance, which affects the influent to a wastewater treatment plant (WWTP) and arguably the microbial community of biological treatment units in a WWTP. In wet weather, contaminants stored in sewer deposits can be resuspended and migrate downstream or be released during combined sewer overflows to the urban water bodies, posing challenges to the treatment facilities or endangering urban water quality. Therefore, in-sewer transformation and migration of contaminants have been extensively studied. The compiled results from representative research in the past few decades showed that biochemical reactions are both cross-sectionally and longitudinally organized in the deposits and the sewage, following the redox potential as well as the sequence of macromolecule/contaminant degradation. The sewage organic contents and sewer biofilm microorganisms were found to covary but more systematic studies are required to examine the temporal stability of the feature. Besides, unique communities can be developed in the sewage phase. The enrichment of the major sewage-associated microorganisms can be explained by the availability of biodegradable organic contents in sewers. The sewer deposits, including biofilms, harbor both microorganisms and contaminants and usually can provide longer residence time for in-sewer transformation than wastewater. However, the interrelationships among contaminant transformation, microorganisms in the deposits/biofilms, and those in the sewage are largely unclear. Specifically, the formation and migration of FOG (fat, oil, and grease) deposits, generation and transport of contaminants in the sewer atmosphere (e.g., H₂S, CH₄, volatile organic compounds, bioaerosols), transport and transformation of nonconventional contaminants, such as pharmaceuticals and personal care products, and wastewater quality variation during the biofilm rehabilitation period after damages caused by rains/storms are some topics for future research. Moreover, systematic and standardized field analysis of real sewers under dynamic wastewater discharge conditions is necessary. We believe that an improved understanding of these processes would assist in sewer management and better prepare us for the challenges brought about by climate change and water shortage.

The role of the sewer system in estimating urban emissions of chemicals of emerging concern

The use of chemicals by society has resulted in calls for more effective control of their emissions. Many of these chemicals are poorly characterized because of lacking data on their use, environmental fate and toxicity, as well as lacking detection techniques. These compounds are sometimes referred to as contaminants of emerging concern (CECs). Urban areas are an important source of CECs, where these are typically first collected in sewer systems and then discharged into the environment after being treated in a wastewater treatment plant. A combination of emission estimation techniques and environmental fate models can support the early identification and management of CEC-related environmental problems. However, scientific insight in the processes driving the fate of CECs in sewer systems is limited and scattered. Biotransformation, sorption and ion-trapping can decrease CEC loads, whereas enzymatic deconjugation of conjugated metabolites can increase CEC loads as metabolites are back-transformed into their parent respective compounds. These fate processes need to be considered when estimating CEC emissions. This literature review collates the fragmented knowledge and data on in-sewer fate of CECs to develop practical guidelines for water managers on how to deal with in-sewer fate of CECs and highlights future research needs. It was assessed to what extent empirical data is in-line with text-book knowledge and integrated sewer modelling approaches. Experimental half-lives (n = 277) of 96 organic CECs were collected from literature. The findings of this literature review can be used to support environmental modelling efforts and to optimize monitoring campaigns, including field studies in the context of wastewater-based epidemiology.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11157-022-09638-9.

Fate characteristics, exposure risk, and control strategy of typical antibiotics in Chinese sewerage system: A review

In China, the sewerage system plays an essential role in antibiotic removal; however, the fate profiles of antibiotics in sewers are not well understood, and risk identification throughout the sewerage system is inadequate. Based on the extensive detection results for typical groups of antibiotics in the discharge sources, influent and effluent from wastewater treatment plants (WWTPs), and excess sludge, a comprehensive evaluation was conducted to reveal the elimination profiles of the antibiotics, identify the fate characteristics in both sewers and WWTPs, assess the exposure risk levels, and propose a control strategy. The total concentration (based on the median concentrations of the target antibiotics) in aqueous waters was estimated to decrease from 7383.4 ng/L at the discharge source to 886.6 ng/L in the WWTP effluent, among which 69.6% was reduced by sewers and 18.4% was reduced by WWTPs. Antibiotic reduction in sewers was a combined effect of dilution, physiochemical reactions, sorption, biodegradation, and retransformation, and the A2O-MBR + ozonation process in the WWTPs exhibited superior performance in diminishing antibiotics. Notably, accumulated antibiotics in the excess sludge posed a high risk to natural environments (with a risk quotient of approximately 13.0), and the potential risk during combined sewer overflows (CSOs) was undetermined. Thus, enhanced sludge treatment techniques, accurate risk prediction, and proper precautions at CSOs are required to mitigate potential risk. A novel scheme involving an accurate estimation of discharge loads, preliminary treatment of highly concentrated discharge sources, and synergic control in sewers was proposed to eliminate antibiotics at the front end of pipes.

Contribution of Illicit Drug Use to Pharmaceutical Load in the Environment: A Focus on Sub-Saharan Africa

Illicit drug abuse and addiction are universal issues requiring international cooperation and interdisciplinary and multisectoral solutions. These addictive substances are utilized for recreational purposes worldwide, including in sub-Saharan Africa. On the other hand, conventional wastewater treatment facilities such as waste stabilization ponds lack the design to remove the most recent classes of pollutants such as illicit drug abuse. As a result, effluents from these treatment schemes contaminate the entire ecosystem. Public health officials are concerned about detecting these pollutants at alarming levels in some countries, with potential undesirable effects on aquatic species and increased health hazards through exposure to contaminated waters or recycling treated or untreated effluents in agriculture. Contaminants including illicit substances enter the environment by human excreta following illegal intake, spills, or through direct dumping, such as from clandestine laboratories, when their manufacturer does not follow accepted production processes. These substances, like other pharmaceuticals, have biological activity and range from pseudopersistent to highly persistent compounds; hence, they persist in the environment while causing harm to the ecosystem. The presence of powerful pharmacological agents such as cocaine, morphine, and amphetamine in water as complex combinations can impair aquatic organisms and human health. These compounds can harm human beings and ecosystem health apart from their low environmental levels. Therefore, this article examines the presence and levels of illicit substances in ecological compartments such as wastewater, surface and ground waters in sub-Saharan Africa, and their latent impact on the ecosystem. The information on the occurrences of illicit drugs and their metabolic products in the sub-Saharan Africa environment and their contribution to pharmaceutical load is missing. In this case, it is important to research further the presence, levels, distribution, and environmental risks of exposure to human beings and the entire ecosystem.

Enhancing sulfide mitigation via the sustainable supply of oxygen from air-nanobubbles in gravity sewers

Traditional air or oxygen injection is an effective and economical mitigation strategy for sulfide control in pressure sewers, but it is not suitable for gravity sewers due to the low solubility of oxygen in water under normal atmospheric conditions. Herein, an air-nanobubble (ANB) injection method was proposed for sulfide mitigation in gravity sewers, and its sulfide control efficiency was evaluated by long-term laboratory gravity sewer reactors. The results showed that an average inhibition rate of 45.36% for sulfide was obtained when ANBs were implemented, which was 3.75 times higher than that of the traditional air injection method, revealing the effectiveness and feasibility of the ANB injection method. As suggested by microbial community analysis of sewer biofilms, the relative abundance of sulfate-reducing bacteria (SRB) decreased 40.57% while that of sulfur oxidizing bacteria (SOB) increased 215.27% in the presence of ANBs, indicating that sulfide mitigation by ANB injection included both the inhibition of sulfide production and the oxidation of dissolved sulfide. The specific cost consumption of ANB injection was 1.7 $/kg-S, which was only 6.85% of that of traditional air injection (24.8 $/kg-S), suggesting that the sustainable supply of oxygen based on ANB injection is not only environmentally but also economically beneficial for sulfide mitigation. The findings of this study may provide an efficient sulfide mitigation strategy for the management of corrosion and malodour issues in the poorly ventilated gravity sewers.

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.

Preparing for COVID-2x: Urban Planning Needs to Regard Urological Wastewater as an Invaluable Communal Public Health Asset and Not as a Burden

Prior to the COVID-19 pandemic, the analysis of urological wastewater had been a matter of academic curiosity and community-wide big-picture studies looking at drug use or the presence of select viruses such as Hepatitis. The COVID-19 pandemic saw systematic testing of urological wastewater emerge as a significant early detection tool for the presence of SARS-CoV-2 in a community. Even though the pandemic still rages in all continents, it is time to consider the post-pandemic world. This paper posits that urban planners should treat urological wastewater as a communal public health asset and that future sewer design should allow for stratified multi-order sampling.

Occurrence, bioaccumulation and toxicological effect of drugs of abuse in aquatic ecosystem: A review

Drugs of abuse are a group of emerging contaminants. As the prevalence of manufacture and consumption, there is a growing global environmental burden and ecological risk from the continuous release of these contaminants into environment. The widespread occurrence of drugs of abuse in waste wasters and surface waters is due to the incomplete removal through traditional wastewater treatment plants in different regions around the world. Although their environmental concentrations are not very high, they can potentially influence the aquatic organisms and ecosystem function. This paper reviews the occurrence of drugs of abuse and their metabolites in waste waters and surface waters, their bioaccumulation in aquatic plants, fishes and benthic organisms and even top predators, and the toxicological effects such as genotoxic effect, cytotoxic effect and even behavioral effect on aquatic organisms. In summary, drugs of abuse occur widely in aquatic environment, and may exert adverse impact on aquatic organisms at molecular, cellular or individual level, and even on aquatic ecosystem. It necessitates the monitoring and risk assessment of these compounds on diverse aquatic organisms in the further study.

Characterization, Spatial Variation and Management Strategy of Sewer Sediments Collected from Combined Sewer System: A Case Study in Longgang District, Shenzhen

In the urban drainage system, the formation of sewer sediments is inevitable, and the removal of sewer sediments is necessary for system maintenance. Disposal of arisings from sewer sediment removal is becoming a serious environmental issue. The current knowledge of sewer sediments is limited, which is restrained to sewer sediments management. To better understand this municipal waste, the sewer sediments of a combined sewer system in Longgang District, Shenzhen were collected and characterized, and the spatial distribution characteristics of contaminants were analyzed. Based on the bivariate correlation analysis, it is found that many contaminants in sewer sediments have a strong relationship with spatial variables. Compared to the sewer sediments in industrial areas, those in residential areas contain higher concentrations of Hg and phosphorus. The sediments in the sewage conduit also contain more organic matter (OM), phosphorus, Cu, and Ni, and the sediments in the rainwater conduit contain a higher concentration of Cd. Moreover, the sediments produced in different catchments also show huge differences in the content of contaminants. These spatial distribution characteristics may provide help for the further classification of sewer sediments, thereby making the disposal of sediments more targeted. According to the local standards of sludge disposal, land application and incineration are not suitable for managing sewer sediments due to the low OM content and poor lower heating value (LHV). Although sanitary landfill is feasible for sewer sediments disposal, the complicated composition of sewer sediments still poses the risk of polluting the surrounding environment. The management of sewer sediments via the production of building materials is a promising technical route that can avoid the migration of hazardous contaminants and produce valuable products. This study may improve our understanding of sewer sediments and provide a reliable recommendation for sewer sediment management.

Effects of pH, Temperature, Suspended Solids, and Biological Activity on Transformation of Illicit Drug and Pharmaceutical Biomarkers in Sewers

In-sewer stability of biomarkers is a critical factor for wastewater-based epidemiology, as it could affect the accuracy of the estimated prevalence of substances in the community. The spatiotemporal variations of environmental and biological conditions in sewers can influence the transformation of biomarkers. To date, the relationship between environmental variables and biomarker stability in sewers is poorly understood. Therefore, this study evaluated the transformation of common illicit drug and pharmaceutical biomarkers in laboratory sewer reactors with different levels of pH, temperature, and suspended solids. The correlations between degradation rates of 14 biomarkers, 3 controlled environmental variables (pH, temperature, and suspended solids concentration), and 3 biological activity indicators (sulfide production rate, methane production rate, and the removal rate of soluble chemical oxygen demand (SCOD)) were assessed using correlation matrix, stepwise regression method, and principal component analysis. The consistent results affirmed the dominant effects of biological activities and pH on biomarker transformation in sewers, particularly for labile compounds, whereas the impact of temperature or suspended solids was less significant. This study enhances the understanding of factors affecting the fate of micropollutants in sewer systems and facilitates the interpretation of WBE results for assessing drug use and public health in communities.

Uncertainties in estimating SARS-CoV-2 prevalence by wastewater-based epidemiology

Wastewater-based epidemiology (WBE) is a promising approach for estimating population-wide COVID-19 prevalence through detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater. However, various methodological challenges associated with WBE would affect the accuracy of prevalence estimation. To date, the overall uncertainty of WBE and the impact of each step on the prevalence estimation are largely unknown. This study divided the WBE approach into five steps (i.e., virus shedding; in-sewer transportation; sampling and storage; analysis of SARS-CoV-2 RNA concentration in wastewater; back-estimation) and further summarized and quantified the uncertainties associated with each step through a systematic review. Although the shedding of SARS-CoV-2 RNA varied greatly between COVID-19 positive patients, with more than 10 infected persons in the catchment area, the uncertainty caused by the excretion rate became limited for the prevalence estimation. Using a high-frequency flow-proportional sampling and estimating the prevalence through actual water usage data significantly reduced the overall uncertainties to around 20-40% (relative standard deviation, RSD). And under such a scenario, the analytical uncertainty of SARS-CoV-2 RNA in wastewater was the dominant factor. This highlights the importance of using surrogate viruses as internal or external standards during the wastewater analysis, and the need for further improvement on analytical approaches to minimize the analytical uncertainty. This study supports the application of WBE as a complementary surveillance strategy for monitoring COVID-19 prevalence and provides methodological improvements and suggestions to enhance the reliability for future studies.