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Driver EM, Ahsan M, Piske L, Lee H, Forrest S, Halden RU, Trieu N. Encrypted data-sharing for preserving privacy in wastewater-based epidemiology. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 940:173315. [PMID: 38761955 DOI: 10.1016/j.scitotenv.2024.173315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 05/20/2024]
Abstract
The rapidly expanding use of wastewater for public health surveillance requires new strategies to protect privacy rights, while data are collected at increasingly discrete geospatial scales, i.e., city, neighborhood, campus, and building-level. Data collected at high geospatial resolution can inform on labile, short-lived biomarkers, thereby making wastewater-derived data both more actionable and more likely to cause privacy concerns and stigmatization of subpopulations. Additionally, data sharing restrictions among neighboring cities and communities can complicate efforts to balance public health protections with citizens' privacy. Here, we have created an encrypted framework that facilitates the sharing of sensitive population health data among entities that lack trust for one another (e.g., between adjacent municipalities with different governance of health monitoring and data sharing). We demonstrate the utility of this approach with two real-world cases. Our results show the feasibility of sharing encrypted data between two municipalities and a laboratory, while performing secure private computations for wastewater-based epidemiology (WBE) with high precision, fast speeds, and low data costs. This framework is amenable to other computations used by WBE researchers including population normalized mass loads, fecal indicator normalizations, and quality control measures. The Centers for Disease Control and Prevention's National Wastewater Surveillance System shows ∼8 % of the records attributed to collection before the wastewater treatment plant, illustrating an opportunity to further expand currently limited community-level sampling and public health surveillance through security and responsible data-sharing as outlined here.
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Affiliation(s)
- Erin M Driver
- Biodesign Center for Environmental Health Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Manazir Ahsan
- Biodesign Center for Biocomputing, Security and Society, Arizona State University, Tempe, AZ 85287, USA; School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ 85287, USA
| | - Lucas Piske
- Biodesign Center for Biocomputing, Security and Society, Arizona State University, Tempe, AZ 85287, USA; School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ 85287, USA
| | - Heewook Lee
- Biodesign Center for Biocomputing, Security and Society, Arizona State University, Tempe, AZ 85287, USA; School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ 85287, USA
| | - Stephanie Forrest
- Biodesign Center for Biocomputing, Security and Society, Arizona State University, Tempe, AZ 85287, USA; School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ 85287, USA; College of Health Solutions, Arizona State University, Tempe, AZ 85287, USA
| | - Rolf U Halden
- Biodesign Center for Environmental Health Engineering, Arizona State University, Tempe, AZ 85287, USA; School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ 85287, USA.
| | - Ni Trieu
- Biodesign Center for Biocomputing, Security and Society, Arizona State University, Tempe, AZ 85287, USA; School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ 85287, USA.
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2
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Paracchini V, Petrillo M, Arcot Rajashekar A, Robuch P, Vincent U, Corbisier P, Tavazzi S, Raffael B, Suffredini E, La Rosa G, Gawlik BM, Marchini A. EU surveys insights: analytical tools, future directions, and the essential requirement for reference materials in wastewater monitoring of SARS-CoV-2, antimicrobial resistance and beyond. Hum Genomics 2024; 18:72. [PMID: 38937848 PMCID: PMC11210120 DOI: 10.1186/s40246-024-00641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Wastewater surveillance (WWS) acts as a vigilant sentinel system for communities, analysing sewage to protect public health by detecting outbreaks and monitoring trends in pathogens and contaminants. To achieve a thorough comprehension of present and upcoming practices and to identify challenges and opportunities for standardisation and improvement in WWS methodologies, two EU surveys were conducted targeting over 750 WWS laboratories across Europe and other regions. The first survey explored a diverse range of activities currently undertaken or planned by laboratories. The second survey specifically targeted methods and quality controls utilised for SARS-CoV-2 surveillance. RESULTS The findings of the two surveys provide a comprehensive insight into the procedures and methodologies applied in WWS. In Europe, WWS primarily focuses on SARS-CoV-2 with 99% of the survey participants dedicated to this virus. However, the responses highlighted a lack of standardisation in the methodologies employed for monitoring SARS-CoV-2. The surveillance of other pathogens, including antimicrobial resistance, is currently fragmented and conducted by only a limited number of laboratories. Notably, these activities are anticipated to expand in the future. Survey replies emphasise the collective recognition of the need to enhance the accuracy of results in WWS practices, reflecting a shared commitment to advancing precision and effectiveness in WWS methodologies. CONCLUSIONS These surveys identified a lack of standardised common procedures in WWS practices and the need for quality standards and reference materials to enhance the accuracy and reliability of WWS methods in the future. In addition, it is important to broaden surveillance efforts beyond SARS-CoV-2 to include other emerging pathogens and antimicrobial resistance to ensure a comprehensive approach to protecting public health.
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Affiliation(s)
| | | | | | - Piotr Robuch
- European Commission, Joint Research Centre (JRC), Geel, Belgium
| | - Ursula Vincent
- European Commission, Joint Research Centre (JRC), Geel, Belgium
| | | | - Simona Tavazzi
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Barbara Raffael
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Elisabetta Suffredini
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Giuseppina La Rosa
- National Center for Water Safety (CeNSia), Istituto Superiore di Sanità (ISS), Rome, Italy
| | | | - Antonio Marchini
- European Commission, Joint Research Centre (JRC), Geel, Belgium.
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3
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Tiwari A, Radu E, Kreuzinger N, Ahmed W, Pitkänen T. Key considerations for pathogen surveillance in wastewater. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 945:173862. [PMID: 38876348 DOI: 10.1016/j.scitotenv.2024.173862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
Wastewater surveillance (WWS) has received significant attention as a rapid, sensitive, and cost-effective tool for monitoring various pathogens in a community. WWS is employed to assess the spatial and temporal trends of diseases and identify their early appearances and reappearances, as well as to detect novel and mutated variants. However, the shedding rates of pathogens vary significantly depending on factors such as disease severity, the physiology of affected individuals, and the characteristics of pathogen. Furthermore, pathogens may exhibit differential fate and decay kinetics in the sewerage system. Variable shedding rates and decay kinetics may affect the detection of pathogens in wastewater. This may influence the interpretation of results and the conclusions of WWS studies. When selecting a pathogen for WWS, it is essential to consider it's specific characteristics. If data are not readily available, factors such as fate, decay, and shedding rates should be assessed before conducting surveillance. Alternatively, these factors can be compared to those of similar pathogens for which such data are available.
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Affiliation(s)
- Ananda Tiwari
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio, Finland; University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland.
| | - Elena Radu
- Institute for Water Quality and Resource Management, Vienna University of Technology, Karlsplatz 13/226, 1040 Vienna, Austria; Stefan S. Nicolau Institute of Virology, Department of Cellular and Molecular Pathology, 285 Mihai Bravu Avenue, 030304 Bucharest, Romania; University of Medicine and Pharmacy Carol Davila, Department of Virology, 37 Dionisie Lupu Street, 020021 Bucharest, Romania.
| | - Norbert Kreuzinger
- Institute for Water Quality and Resource Management, Vienna University of Technology, Karlsplatz 13/226, 1040 Vienna, Austria.
| | - Warish Ahmed
- CSIRO Environment, Ecosciences Precinct, 41 Boggo Road, Dutton Park, QLD 4102, Australia.
| | - Tarja Pitkänen
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio, Finland; University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland.
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4
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Tiwari A, Lehto KM, Paspaliari DK, Al-Mustapha AI, Sarekoski A, Hokajärvi AM, Länsivaara A, Hyder R, Luomala O, Lipponen A, Oikarinen S, Heikinheimo A, Pitkänen T. Developing wastewater-based surveillance schemes for multiple pathogens: The WastPan project in Finland. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 926:171401. [PMID: 38467259 DOI: 10.1016/j.scitotenv.2024.171401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
Wastewater comprises multiple pathogens and offers a potential for wastewater-based surveillance (WBS) to track the prevalence of communicable diseases. The Finnish WastPan project aimed to establish wastewater-based pandemic preparedness for multiple pathogens (viruses, bacteria, parasites, fungi), including antimicrobial resistance (AMR). This article outlines WastPan's experiences in this project, including the criteria for target selection, sampling locations, frequency, analysis methods, and results communication. Target selection relied on epidemiological and microbiological evidence and practical feasibility. Within the WastPan framework, wastewater samples were collected between 2021 and 2023 from 10 wastewater treatment plants (WWTPs) covering 40 % of Finland's population. WWTP selection was validated for reported cases of Extended Spectrum Beta-lactamase-producing bacterial pathogens (Escherichia coli and Klebsiella pneumoniae) from the National Infectious Disease Register. The workflow included 24-h composite influent samples, with one fraction for culture-based analysis (bacteria and fungi) and the rest of the sample was reserved for molecular analysis (viruses, bacteria, antibiotic resistance genes, and parasites). The reproducibility of the monitoring workflow was assessed for SARS-CoV-2 through inter-laboratory comparisons using the N2 and N1 assays. Identical protocols were applied to same-day samples, yielding similar positivity trends in the two laboratories, but the N2 assay achieved a significantly higher detection rate (Laboratory 1: 91.5 %; Laboratory 2: 87.4 %) than the N1 assay (76.6 %) monitored only in Laboratory 2 (McNemar, p < 0.001 Lab 1, = 0.006 Lab 2). This result indicates that the selection of monitoring primers and assays may impact monitoring sensitivity in WBS. Overall, the current study recommends that the selection of sampling frequencies and population coverage of the monitoring should be based on pathogen-specific epidemiological characteristics. For example, pathogens that are stable over time may need less frequent annual sampling, while those that are occurring across regions may require reduced sample coverage. Here, WastPan successfully piloted WBS for monitoring multiple pathogens, highlighting the significance of one-litre community composite wastewater samples for assessing community health. The infrastructure established for COVID-19 WBS is valuable for monitoring various pathogens. The prioritization of the monitoring targets optimizes resource utilization. In the future legislative support in target selection, coverage determination, and sustained funding for WBS is recomended.
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Affiliation(s)
- Ananda Tiwari
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Kirsi-Maarit Lehto
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Dafni K Paspaliari
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland; ECDC Fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Ahmad I Al-Mustapha
- University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland; Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Anniina Sarekoski
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland; University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland.
| | - Anna-Maria Hokajärvi
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Annika Länsivaara
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Rafiqul Hyder
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Oskari Luomala
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Anssi Lipponen
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Sami Oikarinen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Annamari Heikinheimo
- University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland; Finnish Food Authority, Seinäjoki, Finland.
| | - Tarja Pitkänen
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland; University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland.
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5
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Harrington A, Vo V, Moshi MA, Chang CL, Baker H, Ghani N, Itorralba JY, Papp K, Gerrity D, Moser D, Oh EC. Environmental Surveillance of Flood Control Infrastructure Impacted by Unsheltered Individuals Leads to the Detection of SARS-CoV-2 and Novel Mutations in the Spike Gene. ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS 2024; 11:410-417. [PMID: 38752195 PMCID: PMC11095249 DOI: 10.1021/acs.estlett.3c00938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 05/18/2024]
Abstract
In the United States, the growing number of people experiencing homelessness has become a socioeconomic crisis with public health ramifications, recently exacerbated by the COVID-19 pandemic. We hypothesized that the environmental surveillance of flood control infrastructure may be an effective approach to understand the prevalence of infectious disease. From December 2021 through July 2022, we tested for SARS-CoV-2 RNA from two flood control channels known to be impacted by unsheltered individuals residing in upstream tunnels. Using qPCR, we detected SARS-CoV-2 RNA in these environmental water samples when significant COVID-19 outbreaks were occurring in the surrounding community. We also performed whole genome sequencing to identify SARS-CoV-2 lineages. Variant compositions were consistent with those of geographically and temporally matched municipal wastewater samples and clinical specimens. However, we also detected 10 of 22 mutations specific to the Alpha variant in the environmental water samples collected during January 2022-one year after the Alpha infection peak. We also identified mutations in the spike gene that have never been identified in published reports. Our findings demonstrate that environmental surveillance of flood control infrastructure may be an effective tool to understand public health conditions among unsheltered individuals-a vulnerable population that is underrepresented in clinical surveillance data.
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Affiliation(s)
- Anthony Harrington
- Laboratory
of Neurogenetics and Precision Medicine, College of Sciences, Neuroscience Interdisciplinary
Ph.D. program, Department of Brain Health, Department of Internal Medicine, Kirk Kerkorian
School of Medicine at UNLV, University of
Nevada Las Vegas, Las Vegas, Nevada 89154, United States
| | - Van Vo
- Laboratory
of Neurogenetics and Precision Medicine, College of Sciences, Neuroscience Interdisciplinary
Ph.D. program, Department of Brain Health, Department of Internal Medicine, Kirk Kerkorian
School of Medicine at UNLV, University of
Nevada Las Vegas, Las Vegas, Nevada 89154, United States
| | - Michael A. Moshi
- Laboratory
of Neurogenetics and Precision Medicine, College of Sciences, Neuroscience Interdisciplinary
Ph.D. program, Department of Brain Health, Department of Internal Medicine, Kirk Kerkorian
School of Medicine at UNLV, University of
Nevada Las Vegas, Las Vegas, Nevada 89154, United States
| | - Ching-Lan Chang
- Laboratory
of Neurogenetics and Precision Medicine, College of Sciences, Neuroscience Interdisciplinary
Ph.D. program, Department of Brain Health, Department of Internal Medicine, Kirk Kerkorian
School of Medicine at UNLV, University of
Nevada Las Vegas, Las Vegas, Nevada 89154, United States
| | - Hayley Baker
- Laboratory
of Neurogenetics and Precision Medicine, College of Sciences, Neuroscience Interdisciplinary
Ph.D. program, Department of Brain Health, Department of Internal Medicine, Kirk Kerkorian
School of Medicine at UNLV, University of
Nevada Las Vegas, Las Vegas, Nevada 89154, United States
| | - Nabih Ghani
- Laboratory
of Neurogenetics and Precision Medicine, College of Sciences, Neuroscience Interdisciplinary
Ph.D. program, Department of Brain Health, Department of Internal Medicine, Kirk Kerkorian
School of Medicine at UNLV, University of
Nevada Las Vegas, Las Vegas, Nevada 89154, United States
| | - Jose Yani Itorralba
- Laboratory
of Neurogenetics and Precision Medicine, College of Sciences, Neuroscience Interdisciplinary
Ph.D. program, Department of Brain Health, Department of Internal Medicine, Kirk Kerkorian
School of Medicine at UNLV, University of
Nevada Las Vegas, Las Vegas, Nevada 89154, United States
| | - Katerina Papp
- Southern
Nevada Water Authority, P.O. Box 99954, Las Vegas Nevada 89193, United States
| | - Daniel Gerrity
- Southern
Nevada Water Authority, P.O. Box 99954, Las Vegas Nevada 89193, United States
| | - Duane Moser
- Division
of Hydrologic Sciences, Desert Research
Institute, Las Vegas, Nevada 89119, United States
| | - Edwin C. Oh
- Laboratory
of Neurogenetics and Precision Medicine, College of Sciences, Neuroscience Interdisciplinary
Ph.D. program, Department of Brain Health, Department of Internal Medicine, Kirk Kerkorian
School of Medicine at UNLV, University of
Nevada Las Vegas, Las Vegas, Nevada 89154, United States
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6
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Tiwari A, Krolicka A, Tran TT, Räisänen K, Ásmundsdóttir ÁM, Wikmark OG, Lood R, Pitkänen T. Antibiotic resistance monitoring in wastewater in the Nordic countries: A systematic review. ENVIRONMENTAL RESEARCH 2024; 246:118052. [PMID: 38163547 DOI: 10.1016/j.envres.2023.118052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
The Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) have effectively kept lower antibiotic-resistant bacterial (ARB) pathogen rates than many other countries. However, in recent years, these five countries have encountered a rise in ARB cases and challenges in treating infections due to the growing prevalence of ARB pathogens. Wastewater-based surveillance (WBS) is a valuable supplement to clinical methods for ARB surveillance, but there is a lack of comprehensive understanding of WBS application for ARB in the Nordic countries. This review aims to compile the latest state-of-the-art developments in WBS for ARB monitoring in the Nordic countries and compare them with clinical surveillance practices. After reviewing 1480 papers from the primary search, 54 were found relevant, and 15 additional WBS-related papers were included. Among 69 studies analyzed, 42 dedicated clinical epidemiology, while 27 focused on wastewater monitoring. The PRISMA review of the literature revealed that Nordic countries focus on four major WBS objectives of ARB: assessing ARB in the human population, identifying ARB evading wastewater treatment, quantifying removal rates, and evaluating potential ARB evolution during the treatment process. In both clinical and wastewater contexts, the most studied targets were pathogens producing carbapenemase and extended-spectrum beta-lactamase (ESBL), primarily Escherichia coli and Klebsiella spp. However, vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have received more attention in clinical epidemiology than in wastewater studies, probably due to their lower detection rates in wastewater. Clinical surveillance has mostly used culturing, antibiotic susceptibility testing, and genotyping, but WBS employed PCR-based and metagenomics alongside culture-based techniques. Imported cases resulting from international travel and hospitalization abroad appear to have frequently contributed to the rise in ARB pathogen cases in these countries. The many similarities between the Nordic countries (e.g., knowledge exchange practices, antibiotic usage patterns, and the current ARB landscape) could facilitate collaborative efforts in developing and implementing WBS for ARB in population-level screening.
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Affiliation(s)
- Ananda Tiwari
- Expert Microbiology Unit, Finnish Institute for Health and Welfare, 70701, Kuopio, Finland.
| | - Adriana Krolicka
- Norwegian Research Centre AS (NORCE), Nygårdstangen, 5838, Bergen, Norway
| | - Tam T Tran
- Norwegian Research Centre AS (NORCE), Nygårdstangen, 5838, Bergen, Norway
| | - Kati Räisänen
- Expert Microbiology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Odd-Gunnar Wikmark
- Norwegian Research Centre AS (NORCE), Nygårdstangen, 5838, Bergen, Norway; Unit for Environmental Science and Management, North West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa
| | - Rolf Lood
- Department of Clinical Sciences Lund, Division of Infection Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Tarja Pitkänen
- Expert Microbiology Unit, Finnish Institute for Health and Welfare, 70701, Kuopio, Finland; Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland.
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7
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Amirali A, Babler KM, Sharkey ME, Beaver CC, Boone MM, Comerford S, Cooper D, Currall BB, Goodman KW, Grills GS, Kobetz E, Kumar N, Laine J, Lamar WE, Mason CE, Reding BD, Roca MA, Ryon K, Schürer SC, Shukla BS, Solle NS, Stevenson M, Tallon JJ, Vidović D, Williams SL, Yin X, Solo-Gabriele HM. Wastewater based surveillance can be used to reduce clinical testing intensity on a university campus. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 918:170452. [PMID: 38296085 PMCID: PMC10923133 DOI: 10.1016/j.scitotenv.2024.170452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/30/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024]
Abstract
Clinical testing has been a vital part of the response to and suppression of the COVID-19 pandemic; however, testing imposes significant burdens on a population. College students had to contend with clinical testing while simultaneously dealing with health risks and the academic pressures brought on by quarantines, changes to virtual platforms, and other disruptions to daily life. The objective of this study was to analyze whether wastewater surveillance can be used to decrease the intensity of clinical testing while maintaining reliable measurements of diseases incidence on campus. Twelve months of human health and wastewater surveillance data for eight residential buildings on a university campus were analyzed to establish how SARS-CoV-2 levels in the wastewater can be used to minimize clinical testing burden on students. Wastewater SARS-CoV-2 levels were used to create multiple scenarios, each with differing levels of testing intensity, which were compared to the actual testing volumes implemented by the university. We found that scenarios in which testing intensity fluctuations matched rise and falls in SARS-CoV-2 wastewater levels had stronger correlations between SARS-CoV-2 levels and recorded clinical positives. In addition to stronger correlations, most scenarios resulted in overall fewer weekly clinical tests performed. We suggest the use of wastewater surveillance to guide COVID-19 testing as it can significantly increase the efficacy of COVID-19 surveillance while reducing the burden placed on college students during a pandemic. Future efforts should be made to integrate wastewater surveillance into clinical testing strategies implemented on college campuses.
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Affiliation(s)
- Ayaaz Amirali
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, FL 33146, USA
| | - Kristina M Babler
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, FL 33146, USA
| | - Mark E Sharkey
- Department of Medicine, University of Miami Miller School of Medicine, Miami, 33136, FL, USA
| | - Cynthia C Beaver
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Melinda M Boone
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Samuel Comerford
- Department of Medicine, University of Miami Miller School of Medicine, Miami, 33136, FL, USA
| | | | - Benjamin B Currall
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Kenneth W Goodman
- Frost Institute for Data Science & Computing, University of Miami, Coral Gables, FL 33146, USA; Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, 33136, FL, USA
| | - George S Grills
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Erin Kobetz
- Department of Medicine, University of Miami Miller School of Medicine, Miami, 33136, FL, USA
| | - Naresh Kumar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Jennifer Laine
- Environmental Health and Safety, University of Miami, Miami, FL 33136, USA
| | - Walter E Lamar
- Division of Occupational Health, Safety & Compliance, University of Miami Health System, Miami, FL 33136, USA
| | - Christopher E Mason
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York City, NY 10021, USA; The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10021, USA; The WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY 10021, USA
| | - Brian D Reding
- Environmental Health and Safety, University of Miami, Miami, FL 33136, USA
| | - Matthew A Roca
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, FL 33146, USA
| | - Krista Ryon
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York City, NY 10021, USA
| | - Stephan C Schürer
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Molecular & Cellular Pharmacology, University of Miami Miller School of Medicines, Miami, FL 33136, USA; Institute for Data Science & Computing, University of Miami, Coral Gables, FL 33146, USA
| | - Bhavarth S Shukla
- Department of Medicine, University of Miami Miller School of Medicine, Miami, 33136, FL, USA
| | - Natasha Schaefer Solle
- Department of Medicine, University of Miami Miller School of Medicine, Miami, 33136, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Mario Stevenson
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, FL 33146, USA
| | - John J Tallon
- Facilities and Operations, University of Miami, Coral Gables, FL 33146, USA
| | - Dušica Vidović
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, FL 33146, USA
| | - Sion L Williams
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Xue Yin
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, FL 33146, USA
| | - Helena M Solo-Gabriele
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, FL 33146, USA.
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8
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Cohen A, Vikesland P, Pruden A, Krometis LA, Lee LM, Darling A, Yancey M, Helmick M, Singh R, Gonzalez R, Meit M, Degen M, Taniuchi M. Making waves: The benefits and challenges of responsibly implementing wastewater-based surveillance for rural communities. WATER RESEARCH 2024; 250:121095. [PMID: 38181645 DOI: 10.1016/j.watres.2023.121095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/08/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
The sampling and analysis of sewage for pathogens and other biomarkers offers a powerful tool for monitoring and understanding community health trends and potentially predicting disease outbreaks. Since the early months of the COVID-19 pandemic, the use of wastewater-based testing for public health surveillance has increased markedly. However, these efforts have focused on urban and peri‑urban areas. In most rural regions of the world, healthcare service access is more limited than in urban areas, and rural public health agencies typically have less disease outcome surveillance data than their urban counterparts. The potential public health benefits of wastewater-based surveillance for rural communities are therefore substantial - though so too are the methodological and ethical challenges. For many rural communities, population dynamics and insufficient, aging, and inadequately maintained wastewater collection and treatment infrastructure present obstacles to the reliable and responsible implementation of wastewater-based surveillance. Practitioner observations and research findings indicate that for many rural systems, typical implementation approaches for wastewater-based surveillance will not yield sufficiently reliable or actionable results. We discuss key challenges and potential strategies to address them. However, to support and expand the implementation of responsible, reliable, and ethical wastewater-based surveillance for rural communities, best practice guidelines and standards are needed.
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Affiliation(s)
- Alasdair Cohen
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA 24061, USA; Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA.
| | - Peter Vikesland
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Amy Pruden
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Leigh-Anne Krometis
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Lisa M Lee
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA 24061, USA; Division of Scholarly Integrity and Research Compliance, Virginia Tech, Blacksburg, VA 24061, USA
| | - Amanda Darling
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA 24061, USA; Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| | - Michelle Yancey
- Virginia Department of Health, Office of Environmental Health Services, Richmond, VA 23219, USA
| | - Meagan Helmick
- Virginia Department of Health, Mount Rogers Health District, Marion, VA 24354, USA
| | - Rekha Singh
- Virginia Department of Health, Office of Environmental Health Services, Richmond, VA 23219, USA; Department of Civil and Environmental Engineering, Old Dominion University, Norfolk, VA 23529, USA
| | - Raul Gonzalez
- Hampton Roads Sanitation District, Virginia Beach, VA 23455, USA
| | - Michael Meit
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN 37614, USA
| | - Marcia Degen
- Virginia Department of Health, Office of Environmental Health Services, Richmond, VA 23219, USA
| | - Mami Taniuchi
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA; Department of Civil and Environmental Engineering, University of Virginia, Charlottesville, VA 22908, USA; Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22908, USA
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9
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Maal-Bared R, Brisolara K, Knight M, Mansfeldt C. To sample or not to sample: A governance-focused decision tree for wastewater service providers considering participation in wastewater-based epidemiology (WBE) in support of public health programs. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 905:167128. [PMID: 37722431 DOI: 10.1016/j.scitotenv.2023.167128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/20/2023]
Abstract
Wastewater-based epidemiology (WBE) provides value to public health monitoring and protection. Participation of public and private wastewater system operators in WBE efforts is critical to public health surveillance program success and sustainability. However, given the number of WBE solicitations wastewater service providers receive, the limitation of service provider resources, the concerns around privacy, ethics, and equity, and the fatigue associated with responding to COVID-19, operators are becoming more hesitant to participate in WBE efforts. While various ethical concerns and sustainability challenges associated with WBE have been documented, no efforts to date have investigated what factors should systematically influence the decision to provide samples to a WBE effort. Therefore, this study develops a decision-making tool for WBE teams to proactively monitor, manage, and avoid wastewater system operators' operational risks and potential liabilities. Ultimately, using this tool allows WBE program partners in academia, government, and industry to better understand wastewater system operators' needs and challenges surrounding data quality and use, public health ethics, and daily wastewater infrastructure operation.
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Affiliation(s)
| | - Kari Brisolara
- LSUHSC, School of Public Health, 2020 Gravier St, New Orleans, LA, USA.
| | - Mark Knight
- LuminUltra Technologies Ltd, 520 King St, Fredericton, NB E3B 6G3, Canada.
| | - Cresten Mansfeldt
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, 4001 Discovery Drive, Boulder, CO, USA; Environmental Engineering Program, University of Colorado Boulder, 4001 Discovery Drive, Boulder, CO, USA.
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