1
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Schmiege D, Haselhoff T, Thomas A, Kraiselburd I, Meyer F, Moebus S. Small-scale wastewater-based epidemiology (WBE) for infectious diseases and antibiotic resistance: A scoping review. Int J Hyg Environ Health 2024; 259:114379. [PMID: 38626689 DOI: 10.1016/j.ijheh.2024.114379] [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: 01/12/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/18/2024]
Abstract
Wastewater analysis can serve as a source of public health information. In recent years, wastewater-based epidemiology (WBE) has emerged and proven useful for the detection of infectious diseases. However, insights from the wastewater treatment plant do not allow for the small-scale differentiation within the sewer system that is needed to analyze the target population under study in more detail. Small-scale WBE offers several advantages, but there has been no systematic overview of its application. The aim of this scoping review is to provide a comprehensive overview of the current state of knowledge on small-scale WBE for infectious diseases, including methodological considerations for its application. A systematic database search was conducted, considering only peer-reviewed articles. Data analyses included quantitative summary and qualitative narrative synthesis. Of 2130 articles, we included 278, most of which were published since 2020. The studies analyzed wastewater at the building level (n = 203), especially healthcare (n = 110) and educational facilities (n = 80), and at the neighborhood scale (n = 86). The main analytical parameters were viruses (n = 178), notably SARS-CoV-2 (n = 161), and antibiotic resistance (ABR) biomarkers (n = 99), often analyzed by polymerase chain reaction (PCR), with DNA sequencing techniques being less common. In terms of sampling techniques, active sampling dominated. The frequent lack of detailed information on the specification of selection criteria and the characterization of the small-scale sampling sites was identified as a concern. In conclusion, based on the large number of studies, we identified several methodological considerations and overarching strategic aspects for small-scale WBE. An enabling environment for small-scale WBE requires inter- and transdisciplinary knowledge sharing across countries. Promoting the adoption of small-scale WBE will benefit from a common international conceptualization of the approach, including standardized and internationally accepted terminology. In particular, the development of good WBE practices for different aspects of small-scale WBE is warranted. This includes the establishment of guidelines for a comprehensive characterization of the local sewer system and its sub-sewersheds, and transparent reporting to ensure comparability of small-scale WBE results.
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Affiliation(s)
- Dennis Schmiege
- Institute for Urban Public Health (InUPH), University Hospital Essen, University of Duisburg-Essen, 45130, Essen, Germany.
| | - Timo Haselhoff
- Institute for Urban Public Health (InUPH), University Hospital Essen, University of Duisburg-Essen, 45130, Essen, Germany
| | - Alexander Thomas
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, University of Duisburg-Essen, 45131, Essen, Germany
| | - Ivana Kraiselburd
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, University of Duisburg-Essen, 45131, Essen, Germany
| | - Folker Meyer
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, University of Duisburg-Essen, 45131, Essen, Germany
| | - Susanne Moebus
- Institute for Urban Public Health (InUPH), University Hospital Essen, University of Duisburg-Essen, 45130, Essen, Germany
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2
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Anderson LB, Ness HD, Holm RH, Smith T. Wastewater-Informed Digital Advertising as a COVID-19 Geotargeted Neighborhood Intervention: Jefferson County, Kentucky, 2021-2022. Am J Public Health 2024; 114:34-37. [PMID: 37856730 PMCID: PMC10726935 DOI: 10.2105/ajph.2023.307439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/21/2023]
Abstract
We sought to deliver a geotargeted digital health advertising intervention. We assessed risk of community infection through an integrated public health and wastewater rubric and delivered advertisements between November 2021 and April 2022 in Louisville, Kentucky. The average daily click-through rates for the campaigns were 0.19%, 0.15%, and 0.13%. Results show potential for digital public health interventions that are geographically anchored to subcity sewersheds and community interest and willingness to engage with targeted wastewater-themed public health messaging. (Am J Public Health. 2024;114(1):34-37. https://doi.org/10.2105/AJPH.2023.307439).
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Affiliation(s)
- Lauren B Anderson
- Lauren B. Anderson, Heather D. Ness, Rochelle H. Holm, and Ted Smith are with the Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY. L. B. Anderson is also with the Department of Urban and Public Affairs, College of Arts and Sciences, University of Louisville. H. D. Ness is also with the Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville
| | - Heather D Ness
- Lauren B. Anderson, Heather D. Ness, Rochelle H. Holm, and Ted Smith are with the Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY. L. B. Anderson is also with the Department of Urban and Public Affairs, College of Arts and Sciences, University of Louisville. H. D. Ness is also with the Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville
| | - Rochelle H Holm
- Lauren B. Anderson, Heather D. Ness, Rochelle H. Holm, and Ted Smith are with the Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY. L. B. Anderson is also with the Department of Urban and Public Affairs, College of Arts and Sciences, University of Louisville. H. D. Ness is also with the Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville
| | - Ted Smith
- Lauren B. Anderson, Heather D. Ness, Rochelle H. Holm, and Ted Smith are with the Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY. L. B. Anderson is also with the Department of Urban and Public Affairs, College of Arts and Sciences, University of Louisville. H. D. Ness is also with the Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville
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3
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Marin-Ramirez A, Mahoney T, Smith T, Holm RH. Predicting wastewater treatment plant influent in mixed, separate, and combined sewers using nearby surface water discharge for better wastewater-based epidemiology sampling design. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 906:167375. [PMID: 37774884 DOI: 10.1016/j.scitotenv.2023.167375] [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: 07/07/2023] [Revised: 08/28/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
For wastewater sample collection approaches supporting public health applications, few high hydrologic activity normalizing guidelines currently consider readily available environmental flow data that may earlier capture information regarding periods of influent mixing and dilution of wastewater with groundwater and runoff. This study aimed to identify wastewater sampling rules for high hydrological activity events, allowing for an earlier decision point in the control of dilution before sample collection. We defined the sampling rules via data-driven models (Random Forest and linear regression) using environmental data (i.e., wastewater treatment facility influent rates, nearby stream discharge flow, and precipitation). These models were applied to five treatment plants in Jefferson County, Kentucky (USA) in mixed, separate, and combined sewers with different population sizes. We proposed cutoffs of 10 %, 25 %, and 50 % flow conditions for orientation towards public health samples. The results showed a strong nonlinear relationship between nearby stream discharge and treatment facility flow rates, which was used to infer the hydrological conditions that produce high volumes of diluted wastewater in the sewer system. Accumulated Local Effects and SHapley Additive exPlanations aided in deciphering the relationship between the predictors and response variables of the Random Forest models. The influent rate to the treatment plant from the previous day and two USGS stream gages were needed to adequately predict the degree of infiltration and inflow mixing on a given day. Surface water discharge data can be used to provide an earlier workflow decision point during wet weather periods to improve understanding of flow conditions for wastewater-based epidemiological studies to inform laboratory analysis and data interpretation. Not only total flow, but also the specific proportions of infiltration and inflow to wastewater volume in influent should be considered when analyzing data for normalization purposes, and our method provides a starting point for doing so rapidly and at low cost.
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Affiliation(s)
- Arlex Marin-Ramirez
- Department of Civil and Environmental Engineering, J. B. Speed School of Engineering, University of Louisville, 132 E. Pkwy., Louisville, KY 40202, United States
| | - Tyler Mahoney
- Department of Civil and Environmental Engineering, J. B. Speed School of Engineering, University of Louisville, 132 E. Pkwy., Louisville, KY 40202, United States
| | - Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States
| | - Rochelle H Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, United States.
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4
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Bowes D, Darling A, Driver EM, Kaya D, Maal-Bared R, Lee LM, Goodman K, Adhikari S, Aggarwal S, Bivins A, Bohrerova Z, Cohen A, Duvallet C, Elnimeiry RA, Hutchison JM, Kapoor V, Keenum I, Ling F, Sills D, Tiwari A, Vikesland P, Ziels R, Mansfeldt C. Structured Ethical Review for Wastewater-Based Testing in Support of Public Health. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:12969-12980. [PMID: 37611169 PMCID: PMC10484207 DOI: 10.1021/acs.est.3c04529] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023]
Abstract
Wastewater-based testing (WBT) for SARS-CoV-2 has rapidly expanded over the past three years due to its ability to provide a comprehensive measurement of disease prevalence independent of clinical testing. The development and simultaneous application of WBT measured biomarkers for research activities and for the pursuit of public health goals, both areas with well-established ethical frameworks. Currently, WBT practitioners do not employ a standardized ethical review process, introducing the potential for adverse outcomes for WBT professionals and community members. To address this deficiency, an interdisciplinary workshop developed a framework for a structured ethical review of WBT. The workshop employed a consensus approach to create this framework as a set of 11 questions derived from primarily public health guidance. This study retrospectively applied these questions to SARS-CoV-2 monitoring programs covering the emergent phase of the pandemic (3/2020-2/2022 (n = 53)). Of note, 43% of answers highlight a lack of reported information to assess. Therefore, a systematic framework would at a minimum structure the communication of ethical considerations for applications of WBT. Consistent application of an ethical review will also assist in developing a practice of updating approaches and techniques to reflect the concerns held by both those practicing and those being monitored by WBT supported programs.
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Affiliation(s)
- Devin
A. Bowes
- Biodesign
Center for Environmental Health Engineering, The Biodesign Institute, Arizona State University, 1001 S. McAllister Ave, Tempe, Arizona 85287, United States
- Center on
Forced Displacement, Boston University, 111 Cummington Mall, Boston, Massachusetts 02215, United States
| | - Amanda Darling
- Department
of Civil and Environmental Engineering, Virginia Tech, 1145 Perry Street, 415 Durham Hall; Blacksburg, Virginia 24061, United States
| | - Erin M. Driver
- Biodesign
Center for Environmental Health Engineering, The Biodesign Institute, Arizona State University, 1001 S. McAllister Ave, Tempe, Arizona 85287, United States
| | - Devrim Kaya
- School of
Chemical, Biological, and Environmental Engineering, Oregon State University, 105 26th St, Corvallis, Oregon 97331, United States
- School of
Public Health, San Diego State University, San Diego and Imperial Valley, California 92182, United States
| | - Rasha Maal-Bared
- Quality
Assurance and Environment, EPCOR Water Services Inc., EPCOR Tower, 2000−10423 101
Street NW, Edmonton, Alberta T5H 0E7, Canada
| | - Lisa M. Lee
- Department
of Population Health Sciences and Division of Scholarly Integrity
and Research Compliance, Virginia Tech, 300 Turner St. NW, Suite 4120 (0497), Blacksburg, Virginia 24061, United States
| | - Kenneth Goodman
- Institute
for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida 33101, United States
| | - Sangeet Adhikari
- Biodesign
Center for Environmental Health Engineering, The Biodesign Institute, Arizona State University, 1001 S. McAllister Ave, Tempe, Arizona 85287, United States
| | - Srijan Aggarwal
- Department
of Civil, Geological, and Environmental Engineering, University of Alaska Fairbanks, 1764 Tanana Loop, Fairbanks, Alaska 99775, United States
| | - Aaron Bivins
- Department
of Civil & Environmental Engineering, Louisiana State University, 3255 Patrick F. Taylor Hall, Baton Rouge, Louisiana 70803, United States
| | - Zuzana Bohrerova
- The Ohio
State University, Department of Civil, Environmental
and Geodetic Engineering, 2070 Neil Avenue, 470 Hitchcock Hall, Columbus, Ohio 43210, United States
| | - Alasdair Cohen
- Department
of Civil and Environmental Engineering, Virginia Tech, 1145 Perry Street, 415 Durham Hall; Blacksburg, Virginia 24061, United States
- Department
of Population Health Sciences, Virginia
Tech, 205 Duck Pond Drive, Blacksburg, Virginia 24061, United States
| | - Claire Duvallet
- Biobot
Analytics, Inc., 501
Massachusetts Avenue; Cambridge, Massachusetts 02139, United States
| | - Rasha A. Elnimeiry
- Public
Health Outbreak Coordination, Informatics, Surveillance (PHOCIS) Office—Surveillance
Section, Division of Disease Control and Health Statistics, Washington State Department of Health, 111 Israel Rd SE, Tumwater, Washington 98501, United States
| | - Justin M. Hutchison
- Department
of Civil, Environmental, and Architectural Engineering, University of Kansas, 1530 W 15th St, Lawrence, Kansas 66045, United States
| | - Vikram Kapoor
- School
of Civil & Environmental Engineering, and Construction Management, University of Texas at San Antonio, 1 UTSA Circle, San Antonio, Texas 78249, United States
| | - Ishi Keenum
- Complex
Microbial Systems Group, National Institute
of Standards and Technology, 100 Bureau Dr, Gaithersburg, Maryland 20899, United States
| | - Fangqiong Ling
- Department
of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, One Brookings Drive, St. Louis, Missouri 63130, United States
| | - Deborah Sills
- Department
of Civil and Environmental Engineering, Bucknell University, Lewisburg, Pennsylvania 17837, United States
| | - Ananda Tiwari
- Department
of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Agnes Sjöberginkatu 2,
P.O. Box 66, FI 00014 Helsinki, Finland
- Expert
Microbiology Unit, Finnish Institute for
Health and Welfare, FI 70600 Kuopio, Finland
| | - Peter Vikesland
- Department
of Civil and Environmental Engineering, Virginia Tech, 1145 Perry Street, 415 Durham Hall; Blacksburg, Virginia 24061, United States
| | - Ryan Ziels
- Department
of Civil Engineering, The University of
British Columbia, 6250
Applied Science Ln #2002, Vancouver, BC V6T 1Z4, Canada
| | - Cresten Mansfeldt
- Department
of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, UCB 428, Boulder, Colorado 80309, United States
- Environmental
Engineering Program, University of Colorado
Boulder, UCB 607, Boulder, Colorado 80309, United States
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5
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Holm RH, Osborne Jelks N, Schneider R, Smith T. Beyond COVID-19: Designing Inclusive Public Health Surveillance by Including Wastewater Monitoring. Health Equity 2023; 7:377-379. [PMID: 37351532 PMCID: PMC10282970 DOI: 10.1089/heq.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/24/2023] Open
Abstract
Wastewater-based epidemiology is a promising and expanding public health surveillance method. The current wastewater testing trajectory to monitor primarily at community wastewater treatment plants was necessitated by immediate needs of the pandemic. Going forward, specific consideration should be given to monitoring vulnerable and underserved communities to ensure inclusion and rapid response to public health threats. This is particularly important when clinical testing data are insufficient to characterize community virus levels and spread in specific locations. Now is a timely call to action for equitably protecting health in the United States, which can be guided with intentional and inclusive wastewater monitoring.
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Affiliation(s)
- Rochelle H. Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | | | | | - Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
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6
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Joung MJ, Mangat CS, Mejia EM, Nagasawa A, Nichani A, Perez-Iratxeta C, Peterson SW, Champredon D. Coupling wastewater-based epidemiological surveillance and modelling of SARS-COV-2/COVID-19: Practical applications at the Public Health Agency of Canada. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2023; 49:166-174. [PMID: 38404704 PMCID: PMC10890812 DOI: 10.14745/ccdr.v49i05a01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Wastewater-based surveillance (WBS) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) offers a complementary tool for clinical surveillance to detect and monitor coronavirus disease 2019 (COVID-19). Since both symptomatic and asymptomatic individuals infected with SARS-CoV-2 can shed the virus through the fecal route, WBS has the potential to measure community prevalence of COVID-19 without restrictions from healthcare-seeking behaviours and clinical testing capacity. During the Omicron wave, the limited capacity of clinical testing to identify COVID-19 cases in many jurisdictions highlighted the utility of WBS to estimate disease prevalence and inform public health strategies; however, there is a plethora of in-sewage, environmental and laboratory factors that can influence WBS outcomes. The implementation of WBS, therefore, requires a comprehensive framework to outline a pipeline that accounts for these complex and nuanced factors. This article reviews the framework of the national WBS conducted at the Public Health Agency of Canada to present WBS methods used in Canada to track and monitor SARS-CoV-2. In particular, we focus on five Canadian cities-Vancouver, Edmonton, Toronto, Montréal and Halifax-whose wastewater signals are analyzed by a mathematical model to provide case forecasts and reproduction number estimates. The goal of this work is to share our insights on approaches to implement WBS. Importantly, the national WBS system has implications beyond COVID-19, as a similar framework can be applied to monitor other infectious disease pathogens or antimicrobial resistance in the community.
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Affiliation(s)
- Meong Jin Joung
- National Microbiology Laboratory, Public Health Risk Sciences Division, Public Health Agency of Canada, Guelph, ON
- Dalla Lana School of Public Health, University of Toronto. Toronto, ON
| | - Chand S Mangat
- National Microbiology Laboratory, Wastewater Surveillance Unit, Public Health Agency of Canada, Winnipeg, MB
| | - Edgard M Mejia
- National Microbiology Laboratory, Wastewater Surveillance Unit, Public Health Agency of Canada, Winnipeg, MB
| | - Audra Nagasawa
- Statistics Canada, Centre for Direct Health Measures, Ottawa, ON
| | - Anil Nichani
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON
| | | | - Shelley W Peterson
- National Microbiology Laboratory, Wastewater Surveillance Unit, Public Health Agency of Canada, Winnipeg, MB
| | - David Champredon
- National Microbiology Laboratory, Public Health Risk Sciences Division, Public Health Agency of Canada, Guelph, ON
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7
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Smith T, Holm RH, Keith RJ, Amraotkar AR, Alvarado CR, Banecki K, Choi B, Santisteban IC, Bushau-Sprinkle AM, Kitterman KT, Fuqua J, Hamorsky KT, Palmer KE, Brick JM, Rempala GA, Bhatnagar A. Quantifying the relationship between sub-population wastewater samples and community-wide SARS-CoV-2 seroprevalence. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 853:158567. [PMID: 36084773 PMCID: PMC9444845 DOI: 10.1016/j.scitotenv.2022.158567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/07/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
Robust epidemiological models relating wastewater to community disease prevalence are lacking. Assessments of SARS-CoV-2 infection rates have relied primarily on convenience sampling, which does not provide reliable estimates of community disease prevalence due to inherent biases. This study conducted serial stratified randomized samplings to estimate the prevalence of SARS-CoV-2 antibodies in 3717 participants, and obtained weekly samples of community wastewater for SARS-CoV-2 concentrations in Jefferson County, KY (USA) from August 2020 to February 2021. Using an expanded Susceptible-Infected-Recovered model, the longitudinal estimates of the disease prevalence were obtained and compared with the wastewater concentrations using regression analysis. The model analysis revealed significant temporal differences in epidemic peaks. The results showed that in some areas, the average incidence rate, based on serological sampling, was 50 % higher than the health department rate, which was based on convenience sampling. The model-estimated average prevalence rates correlated well with the wastewater (correlation = 0.63, CI (0.31,0.83)). In the regression analysis, a one copy per ml-unit increase in weekly average wastewater concentration of SARS-CoV-2 corresponded to an average increase of 1-1.3 cases of SARS-CoV-2 infection per 100,000 residents. The analysis indicates that wastewater may provide robust estimates of community spread of infection, in line with the modeled prevalence estimates obtained from stratified randomized sampling, and is therefore superior to publicly available health data.
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Affiliation(s)
- Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Rochelle H Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Rachel J Keith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Alok R Amraotkar
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Chance R Alvarado
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Krzysztof Banecki
- Laboratory of Bioinformatics and Computational Genomics, Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Boseung Choi
- Division of Big Data Science, Korea University, Sejong, South Korea; Biomedical Mathematics Group, Institute for Basic Science, Daejeon, South Korea
| | - Ian C Santisteban
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, Louisville, KY 40202, USA
| | - Adrienne M Bushau-Sprinkle
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, Louisville, KY 40202, USA; Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Kathleen T Kitterman
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, Louisville, KY 40202, USA
| | - Joshua Fuqua
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, Louisville, KY 40202, USA; Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Krystal T Hamorsky
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, Louisville, KY 40202, USA; Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Kenneth E Palmer
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, Louisville, KY 40202, USA; Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | | | - Grzegorz A Rempala
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY 40202, USA.
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8
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Smith T, Holm RH, Yeager R, Moore JB, Rouchka EC, Sokoloski KJ, Elliott EM, Talley D, Arora V, Moyer S, Bhatnagar A. Combining Community Wastewater Genomic Surveillance with State Clinical Surveillance: A Framework for SARS-CoV-2 Public Health Practice. FOOD AND ENVIRONMENTAL VIROLOGY 2022; 14:410-416. [PMID: 35982363 PMCID: PMC9387882 DOI: 10.1007/s12560-022-09531-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/31/2022] [Indexed: 05/16/2023]
Abstract
This study aimed to develop a framework for combining community wastewater surveillance with state clinical surveillance for the confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants within the community and to provide recommendations on how to expand on such research and apply the findings in public health responses. Wastewater samples were collected weekly from 17 geographically resolved locations in Louisville/Jefferson County, Kentucky (USA), from February 10 to December 13, 2021. Genomic surveillance and quantitative reverse transcription PCR (RT-qPCR) platforms were used to screen for SARS-CoV-2 in wastewater, and state clinical surveillance was used for confirmation. The study results highlighted an increased epidemiological value of combining community wastewater genomic surveillance and RT-qPCR with conventional case-auditing methods. The spatial scale and temporal frequency of wastewater sampling provided promising sensitivity and specificity for gaining public health screening insights about SARS-CoV-2 emergence, seeding, and spread in communities. Improved national surveillance systems are needed against future pathogens and variants, and wastewater-based genomic surveillance exhibits great potential when coupled with clinical testing. This paper presents evidence that complementary wastewater and clinical testing are cost-effectively enhanced when used in combination, as they provide a strong tool for a joint public health framework. Future pathogens of interest may be examined in either a targeted fashion or using a more global approach where all pathogens are monitored. This study has also provided novel insights developed from evidence-based public health practices.
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Affiliation(s)
- Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY, 40202, USA
| | - Rochelle H Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY, 40202, USA.
| | - Ray Yeager
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY, 40202, USA
- Center for Integrative Environmental Health Sciences, School of Medicine, University of Louisville, 500 S. Preston St., Louisville, KY, 40202, USA
| | - Joseph B Moore
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY, 40202, USA
- Diabetes and Obesity Center, School of Medicine, University of Louisville, 580 S. Preston St., Louisville, KY, 40202, USA
| | - Eric C Rouchka
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Louisville, 319 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Kevin J Sokoloski
- Department of Microbiology and Immunology, School of Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY, 40202, USA
- Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, University of Louisville, 505 S. Hancock St., Louisville, KY, 40202, USA
| | - Erin M Elliott
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY, 40202, USA
- Diabetes and Obesity Center, School of Medicine, University of Louisville, 580 S. Preston St., Louisville, KY, 40202, USA
| | - Daymond Talley
- Morris Forman Water Quality Treatment Center, Louisville/Jefferson County Metropolitan Sewer District, 4522 Algonquin Parkway, Louisville, KY, 40211, USA
| | - Vaneet Arora
- Division of Laboratory Services, Kentucky Department for Public Health, 100 Sower Blvd., Suite 204, Frankfort, KY, 40601, USA
- Department of Pathology and Laboratory Medicine, University of Kentucky, 800 Rose St., Lexington, KY, 40536, USA
| | - Sarah Moyer
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY, 40202, USA
- Department of Public Health and Wellness, Louisville-Jefferson County Metro Government, 400 E. Gray St., Louisville, KY, 40202, USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY, 40202, USA
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9
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Lancaster E, Byrd K, Ai Y, Lee J. Socioeconomic status correlations with confirmed COVID-19 cases and SARS-CoV-2 wastewater concentrations in small-medium sized communities. ENVIRONMENTAL RESEARCH 2022; 215:114290. [PMID: 36096171 PMCID: PMC9458761 DOI: 10.1016/j.envres.2022.114290] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/16/2022] [Accepted: 09/04/2022] [Indexed: 06/15/2023]
Abstract
Over two years into the COVID-19 pandemic, it is apparent that some populations across the world are more susceptible than others to SARS-CoV-2 infection and spread. Understanding how populations with varying demographic patterns are impacted by COVID-19 may highlight which factors are most important in targeting to combat global suffering. The first objective of this study was to investigate the association of various socioeconomic status (SES) parameters and confirmed COVID-19 cases in the state of Ohio, USA. This study examines the largest and capital city of Ohio (Columbus) and various small-medium-sized communities. The second objective was to determine the relationship between SES parameters and community-level SARS-CoV-2 concentrations using municipal wastewater samples from each city's respective wastewater treatment plants from August 2020 to January 2021. SES parameters include population size, median income, poverty, race/ethnicity, education, health care access, types of COVID-19 testing sites, and social vulnerability index. Statistical analysis results show that confirmed (normalized and/or non-normalized) COVID-19 cases were negatively associated with White percentage and registered hospitals, and positively associated with registered physicians and various COVID-19 testing sites. Wastewater viral concentrations were negatively associated with poverty, and positively associated with median income, community health centers, and onsite rapid testing locations. Additional analyses conclude that population is a significant factor in determining COVID-19 cases and SARS-CoV-2 wastewater concentrations. Results indicate that community healthcare parameters relate to a negative health outcome (COVID-19) and that demographic parameters can be associated with community-level SARS-CoV-2 wastewater concentrations. As the first study that examines the association between socioeconomic parameters and SARS-CoV-2 wastewater concentrations as well as confirmed COVID-19 cases, it is apparent that social determinants have an impact in determining the health burden of small-medium sized Ohioan cities. This study design and innovative approach are scalable and applicable for endemic and pandemic surveillance across the world.
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Affiliation(s)
- Emma Lancaster
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA; Environmental Sciences Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Kendall Byrd
- Environmental Sciences Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Yuehan Ai
- Department of Food Science & Technology, The Ohio State University, Columbus, OH, USA
| | - Jiyoung Lee
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA; Environmental Sciences Graduate Program, The Ohio State University, Columbus, OH, USA; Department of Food Science & Technology, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, Columbus, OH, USA.
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10
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Standards to support an enduring capability in wastewater surveillance for public health: Where are we? CASE STUDIES IN CHEMICAL AND ENVIRONMENTAL ENGINEERING 2022; 6:100247. [PMID: 37520917 PMCID: PMC9376981 DOI: 10.1016/j.cscee.2022.100247] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 06/02/2023]
Abstract
The COVID-19 pandemic highlighted a wide range of public health system challenges for infectious disease surveillance. The discovery that the SARS-CoV-2 virus was shed in feces and can be characterized using PCR-based testing of sewage samples offers new possibilities and challenges for wastewater surveillance (WWS). However, WWS standardization of practices is needed to provide actionable data for a public health response. A workshop was convened consisting of academic, federal government, and industry stakeholders. The objective was to review WWS sampling protocols, testing methods, analyses, and data interpretation approaches for WWS employed nationally and identify opportunities for standardizing practices, including the development of documentary standards or reference materials in the case of SARS-CoV-2 surveillance. Other WWS potential future threats to public health were also discussed. Several aspects of WWS were considered and each offers the opportunity for standards development. These areas included sampling strategies, analytical methods, and data reporting practices. Each of these areas converged on a common theme, the challenge of results comparability across facilities and jurisdictions. For sampling, the consensus solution was the development of documentary standards to guide appropriate sampling practices. In contrast, the predominant opportunity for analytical methods was reference material development, such as PCR-based standards and surrogate recovery controls. For data reporting practices, the need for establishing the minimal required metadata, a metadata vocabulary, and standardizing data units of measure including measurement threshold definitions was discussed. Beyond SARS-CoV-2 testing, there was general agreement that the WWS platform will continue to be a valuable tool for a wide range of public health threats and that future cross-sector engagements are needed to guide an enduring WWS capability.
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11
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Holm RH, Brick JM, Amraotkar AR, Hart JL, Mukherjee A, Zeigler J, Bushau-Sprinkle AM, Anderson LB, Walker KL, Talley D, Keith RJ, Rai SN, Palmer KE, Bhatnagar A, Smith T. Public Awareness of and Support for the Use of Wastewater for SARS-CoV-2 Monitoring: A Community Survey in Louisville, Kentucky. ACS ES&T WATER 2022; 2:1891-1898. [PMID: 37552721 PMCID: PMC9063986 DOI: 10.1021/acsestwater.1c00405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 05/16/2023]
Abstract
The majority of sewer systems in the United States and other countries are operated by public utilities. In the absence of any regulation, the public perception of wastewater monitoring for population health biomarkers is an important consideration for a public utility commission when allocating resources for this purpose. We conducted a survey in August 2021 as part of an ongoing COVID-19 community prevalence study in Louisville/Jefferson County, KY, US. The survey comprised seven questions about wastewater awareness and privacy concerns and was sent to approximately 35 000 households randomly distributed within the county. A total of 1220 adults were involved in the probability sample, and data from 981 respondents were used in the analysis. A total of 2444 adults additionally responded to the convenience sample, and data from 1751 respondents were used in the analysis. The samples were weighted to obtain estimates representative of all adults in the county. Public awareness of tracking the virus that causes COVID-19 in sewers was low. Opinions strongly support the public disclosure of monitoring results. Responses showed that people more strongly supported measurements in the largest areas (>50 000 households), typically representing population levels found in a large community wastewater treatment plant. Those with a history of COVID-19 infection were more likely to support highly localized monitoring. Understanding wastewater surveillance strategies and privacy concern thresholds requires an in-depth and comprehensive analysis of public opinion for continued success and effective public health monitoring.
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Affiliation(s)
- Rochelle H. Holm
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
| | - J. Michael Brick
- Westat, Incorporated, 1600
Research Boulevard, Rockville, Maryland 20850, United States
| | - Alok R. Amraotkar
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
| | - Joy L. Hart
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
- Department of Communication, College of Arts and
Sciences, University of Louisville, 2010 South Avery Court
Walk, Louisville, Kentucky 40208, United States
| | - Anish Mukherjee
- Department of Bioinformatics and Biostatistics, School
of Public Health and Information Science, University of
Louisville, 505 South Hancock Street, Louisville, Kentucky 40202,
United States
| | - Jacob Zeigler
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
| | - Adrienne M. Bushau-Sprinkle
- Center for Predictive Medicine for Biodefense and
Emerging Infectious Diseases, University of Louisville, 505
South Hancock Street, Louisville, Kentucky 40202, United States
| | - Lauren B. Anderson
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
- Center for Healthy Air, Water and Soil,
University of Louisville, 302 East Muhammad Ali Boulevard,
Louisville, Kentucky 40202, United States
| | - Kandi L. Walker
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
- Department of Communication, College of Arts and
Sciences, University of Louisville, 2010 South Avery Court
Walk, Louisville, Kentucky 40208, United States
| | - Daymond Talley
- Louisville/Jefferson County Metropolitan
Sewer District, Morris Forman Water Quality Treatment Center, 4522
Algonquin Parkway, Louisville, Kentucky 40211, United States
| | - Rachel J. Keith
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
| | - Shesh N. Rai
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
- Department of Bioinformatics and Biostatistics, School
of Public Health and Information Science, University of
Louisville, 505 South Hancock Street, Louisville, Kentucky 40202,
United States
- Brown Cancer Center, School of Medicine,
University of Louisville, 505 South Hancock Street,
Louisville, Kentucky 40202, United States
- Center for Integrative Environmental
Health Sciences, 500 South Preston Street, Louisville, Kentucky 40202,
United States
| | - Kenneth E. Palmer
- Center for Predictive Medicine for Biodefense and
Emerging Infectious Diseases, University of Louisville, 505
South Hancock Street, Louisville, Kentucky 40202, United States
- Department of Pharmacology and Toxicology, School of
Medicine, University of Louisville, 323 East Chestnut Street,
Louisville, Kentucky 40202, United States
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
| | - Ted Smith
- Christina Lee Brown Envirome Institute, School of
Medicine, University of Louisville, 302 East Muhammad Ali
Boulevard, Louisville, Kentucky 40202, United States
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12
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LaJoie AS, Holm RH, Anderson LB, Ness HD, Smith T. Nationwide public perceptions regarding the acceptance of using wastewater for community health monitoring in the United States. PLoS One 2022; 17:e0275075. [PMID: 36219594 PMCID: PMC9553059 DOI: 10.1371/journal.pone.0275075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022] Open
Abstract
To assess the levels of infection across communities during the coronavirus disease 2019 pandemic, researchers have measured severe acute respiratory syndrome coronavirus 2 RNA in feces dissolved in sewer water. This activity is colloquially known as sewer monitoring and is referred to as wastewater-based epidemiology in academic settings. Although global ethical principles have been described, sewer monitoring is unregulated for health privacy protection when used for public health surveillance in the United States. This study used Qualtrics XM, a national research panel provider, to recruit participants to answer an online survey. Respondents (N = 3,083) answered questions about their knowledge, perceptions of what is to be monitored, where monitoring should occur, and privacy concerns related to sewer monitoring as a public health surveillance tool. Furthermore, a privacy attitude questionnaire was used to assess the general privacy boundaries of respondents. Participants were more likely to support monitoring for diseases (92%), environmental toxins (92%), and terrorist threats (88%; e.g., anthrax). Two-third of the respondents endorsed no prohibition on location sampling scale (e.g., monitoring single residence to entire community was acceptable); the most common location category respondents wanted to prohibit sampling was at personal residences. Sewer monitoring is an emerging technology, and our study sheds light on perceptions that could benefit from educational programs in areas where public acceptance is comparatively lower. Respondents clearly communicated guard rails for sewer monitoring, and public opinion should inform future policy, application, and regulation measures.
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Affiliation(s)
- A. Scott LaJoie
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Rochelle H. Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
- * E-mail:
| | - Lauren B. Anderson
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Heather D. Ness
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
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13
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Akingbola S, Fernandes R, Borden S, Gilbride K, Oswald C, Straus S, Tehrani A, Thomas J, Stuart R. Early identification of a COVID-19 outbreak detected by wastewater surveillance at a large homeless shelter in Toronto, Ontario. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 114:72-79. [PMID: 36156197 PMCID: PMC9512955 DOI: 10.17269/s41997-022-00696-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 09/01/2022] [Indexed: 01/21/2023]
Abstract
SETTING Toronto (Ontario, Canada) is a large urban centre with a significant population of underhoused residents and several dozen shelters for this population with known medical and social vulnerabilities. A sizeable men's homeless shelter piloted a facility-level SARS-CoV-2 wastewater surveillance program. INTERVENTION Wastewater surveillance was initiated at the shelter in January 2021. One-hour composite wastewater samples were collected twice weekly from a terminal sanitary clean-out pipe. The genetic material of the SARS-CoV-2 virus was extracted from the solid phase of each sample and analyzed using real-time qPCR to estimate the viral level. Wastewater results were reported to facility managers and Toronto Public Health within 4 days. OUTCOMES There were 169 clients on-site at the time of the investigation. Wastewater surveillance alerted to the presence of COVID-19 activity at the site, prior to clinical detection. This notification acted as an early warning signal, which allowed for timely symptom screening and case finding for shelter managers and the local health unit, in preparation for the declaration of an outbreak. IMPLICATIONS Wastewater surveillance acted as an advanced notification leading to the timely deployment of enhanced testing prior to clinical presentation in a population with known vulnerabilities. Wastewater surveillance at the facility level is beneficial, particularly in high-risk congregate living settings such as shelters that house transient populations where clinical testing and vaccination can be challenging. Open communication, established individual facility response plans, and a balanced threshold for action are essential to an effective wastewater surveillance program.
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Affiliation(s)
| | | | - Susan Borden
- Toronto Public Health, Toronto, ON Canada ,Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | - Kimberley Gilbride
- Department of Chemistry and Biology, Toronto Metropolitan University, Toronto, ON Canada
| | - Claire Oswald
- Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, ON Canada
| | - Sharon Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada ,Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Amir Tehrani
- Department of Chemistry and Biology, Toronto Metropolitan University, Toronto, ON Canada
| | - Janis Thomas
- Ontario Ministry of the Environment and Parks, Toronto, ON Canada
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14
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Hill DT, Cousins H, Dandaraw B, Faruolo C, Godinez A, Run S, Smith S, Willkens M, Zirath S, Larsen DA. Wastewater treatment plant operators report high capacity to support wastewater surveillance for COVID-19 across New York State, USA. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 837:155664. [PMID: 35526635 PMCID: PMC9072752 DOI: 10.1016/j.scitotenv.2022.155664] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 05/28/2023]
Abstract
Wastewater surveillance for infectious disease expanded greatly during the COVID-19 pandemic. As a collaboration between sanitation engineers and scientists, the most cost-effective deployment of wastewater surveillance routinely tests wastewater samples from wastewater treatment plants. To evaluate the capacity of treatment plants of different sizes and characteristics to participate in surveillance efforts, we developed and distributed a survey to New York State municipal treatment plant supervisors in the summer and fall of 2021. The goal of the survey was to assess the knowledge, capacity, and attitudes toward wastewater surveillance as a public health tool. Our objectives were to: (1) determine what treatment plant operators know about wastewater surveillance for public health; (2) assess how plant operators feel about the affordability and benefits of wastewater surveillance; and (3) determine how frequently plant personnel can take and ship samples using existing resources. Results show that 62% of respondents report capacity to take grab samples twice weekly. Knowledge about wastewater surveillance was mixed with most supervisors knowing that COVID-19 can be tracked via wastewater but having less knowledge about surveillance for other public health issues such as opioids. We found that attitudes toward wastewater testing for public health were directly associated with differences in self-reported capacity of the plant to take samples. Further, findings suggest a diverse capacity for sampling across sewer systems with larger treatment plants reporting greater capacity for more frequent sampling. Findings provide guidance for outreach activities as well as important insight into treatment plant sampling capacity as it is connected to internal factors such as size and resource availability. These may help public health departments understand the limitations and ability of wastewater surveillance for public health benefit.
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Affiliation(s)
- Dustin T Hill
- Department of Public Health, Syracuse University, Syracuse, NY 13244, United States of America.
| | - Hannah Cousins
- Department of Biology, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Bryan Dandaraw
- Department of Environmental Science, SUNY College of Environmental Science and Forestry, Syracuse, NY 13210, United States of America
| | - Catherine Faruolo
- Department of Public Health, Syracuse University, Syracuse, NY 13244, United States of America
| | - Alex Godinez
- Department of Public Health, Syracuse University, Syracuse, NY 13244, United States of America
| | - Sythong Run
- Department of Public Health, Syracuse University, Syracuse, NY 13244, United States of America
| | - Simon Smith
- Department of Public Health, Syracuse University, Syracuse, NY 13244, United States of America
| | - Megan Willkens
- Department of Public Health, Syracuse University, Syracuse, NY 13244, United States of America
| | - Shruti Zirath
- Department of Environmental Science, SUNY College of Environmental Science and Forestry, Syracuse, NY 13210, United States of America
| | - David A Larsen
- Department of Public Health, Syracuse University, Syracuse, NY 13244, United States of America
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15
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Bowes DA, Driver EM, Halden RU. A framework for wastewater sample collection from a sewage cleanout to inform building-scale wastewater-based epidemiology studies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 836:155576. [PMID: 35504397 DOI: 10.1016/j.scitotenv.2022.155576] [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: 03/09/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
Wastewater-based epidemiology (WBE) is a public health tool utilized for drug surveillance, and more recently, infectious disease monitoring of SARS-CoV-2. Sample collection is historically performed at a wastewater treatment plant, however, at this spatial resolution, much information related to actionable and contextually relevant community health data may be lost. Sampling from within the sewer collection system is now being employed more widely, bringing unique challenges, including health and safety concerns related to sample collection. As proof of concept, we tested the efficacy of sampling at the building-level from a sewer cleanout at an undisclosed location in Greater Phoenix, AZ, USA, to (i) test the feasibility of wastewater sample collection from this alternative access point, (ii) assess the advantages and limitations experienced for both maintenance-hole and cleanout-level sampling, (iii) screen for chemical analytes to evaluate detectability, and (iv) create a sampling framework for future near-source WBE investigations. Results indicate that use of a sewer cleanout compared to a maintenance hole is cost-effective, practical, and safe, while still preserving the anonymity and privacy for the contributing population. Additionally, of the 37 biomarkers screened over two sampling events, 20 were detected that cover a wide range of human behavior, exposure, and activity, indicating use of a sewer cleanout to be entirely feasible for downstream analysis. This reported success of sewer cleanout sampling for WBE and corresponding framework may allow practitioners to isolate specific complexes or buildings of interest, while avoiding challenges that can arise from maintenance hole sampling, thus allowing for widescale implementation of WBE for public health purposes.
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Affiliation(s)
- Devin A Bowes
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; School for Engineering of Matter, Transport, and Energy, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA
| | - Erin M Driver
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA
| | - Rolf U Halden
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; School for Sustainable Engineering and the Built Environment, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; OneWaterOneHealth, The Arizona State University Foundation, The Biodesign Institute, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA; Global Futures Laboratory, Arizona State University, 800 S. Cady Mall, Tempe, AZ 85281, USA.
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16
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Wu F, Lee WL, Chen H, Gu X, Chandra F, Armas F, Xiao A, Leifels M, Rhode SF, Wuertz S, Thompson J, Alm EJ. Making waves: Wastewater surveillance of SARS-CoV-2 in an endemic future. WATER RESEARCH 2022; 219:118535. [PMID: 35605390 PMCID: PMC9062764 DOI: 10.1016/j.watres.2022.118535] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 05/28/2023]
Abstract
Wastewater-based surveillance (WBS) has been widely used as a public health tool to monitor the emergence and spread of SARS-CoV-2 infections in populations during the COVID-19 pandemic. Coincident with the global vaccination efforts, the world is also enduring new waves of SARS-CoV-2 variants. Reinfections and vaccine breakthroughs suggest an endemic future where SARS-CoV-2 continues to persist in the general population. In this treatise, we aim to explore the future roles of wastewater surveillance. Practically, WBS serves as a relatively affordable and non-invasive tool for mass surveillance of SARS-CoV-2 infection while minimizing privacy concerns, attributes that make it extremely suited for its long-term usage. In an endemic future, the utility of WBS will include 1) monitoring the trend of viral loads of targets in wastewater for quantitative estimate of changes in disease incidence; 2) sampling upstream for pinpointing infections in neighborhoods and at the building level; 3) integrating wastewater and clinical surveillance for cost-efficient population surveillance; and 4) genome sequencing wastewater samples to track circulating and emerging variants in the population. We further discuss the challenges and future developments of WBS to reduce inconsistencies in wastewater data worldwide, improve its epidemiological inference, and advance viral tracking and discovery as a preparation for the next viral pandemic.
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Affiliation(s)
- Fuqing Wu
- Center for Infectious Disease, Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA.
| | - Wei Lin Lee
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Hongjie Chen
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Xiaoqiong Gu
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Franciscus Chandra
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Federica Armas
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Amy Xiao
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA; Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Mats Leifels
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | | | - Stefan Wuertz
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore; Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore; School of Civil and Environmental Engineering, Nanyang Technological University, Singapore
| | - Janelle Thompson
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore; Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore; Asian School of the Environment, Nanyang Technological University, Singapore
| | - Eric J Alm
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA; Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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17
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Kapoor V, Al-Duroobi H, Phan DC, Palekar RS, Blount B, Rambhia KJ. Wastewater surveillance for SARS-CoV-2 to support return to campus: Methodological considerations and data interpretation. CURRENT OPINION IN ENVIRONMENTAL SCIENCE & HEALTH 2022; 27:100362. [PMID: 35402756 PMCID: PMC8975751 DOI: 10.1016/j.coesh.2022.100362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The COVID-19 pandemic has been challenging for various institutions such as school systems due to widespread closures. As schools re-open their campuses to in-person education, there is a need for frequent screening and monitoring of the virus to ensure the safety of students and staff and to limit risk to the surrounding community. Wastewater surveillance (WWS) of SARS-CoV-2 is a rapid and economical approach to determine the extent of COVID-19 in the community. The focus of this review is on the emergence of WWS as a tool for safe return to school campuses, taking into account methodological considerations such as site selection, sample collection and processing, SARS-CoV-2 quantification, and data interpretation. Recently published studies on the implementation of COVID-19 WWS on school and college campuses were reviewed. While there are several logistical and technical challenges, WWS can be used to inform decision-making at the school campus and/or building level.
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Affiliation(s)
- Vikram Kapoor
- School of Civil & Environmental Engineering, and Construction Management, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Haya Al-Duroobi
- School of Civil & Environmental Engineering, and Construction Management, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Duc C Phan
- School of Civil & Environmental Engineering, and Construction Management, University of Texas at San Antonio, San Antonio, TX 78249, USA
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18
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Zdenkova K, Bartackova J, Cermakova E, Demnerova K, Dostalkova A, Janda V, Jarkovsky J, Lopez Marin MA, Novakova Z, Rumlova M, Ambrozova JR, Skodakova K, Swierczkova I, Sykora P, Vejmelkova D, Wanner J, Bartacek J. Monitoring COVID-19 spread in Prague local neighborhoods based on the presence of SARS-CoV-2 RNA in wastewater collected throughout the sewer network. WATER RESEARCH 2022. [PMID: 35358873 DOI: 10.1101/2021.07.28.21261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Many reports have documented that the presence of SARS-CoV-2 RNA in the influents of municipal wastewater treatment plants (WWTP) correlates with the actual epidemic situation in a given city. However, few data have been reported thus far on measurements upstream of WWTPs, i.e. throughout the sewer network. In this study, the monitoring of the presence of SARS-CoV-2 RNA in Prague wastewater was carried out at selected locations of the Prague sewer network from August 2020 through May 2021. Various locations such as residential areas of various sizes, hospitals, city center areas, student dormitories, transportation hubs (airport, bus terminal), and commercial areas were monitored together with four of the main Prague sewers. The presence of SARS-CoV-2 RNA was determined by reverse transcription - multiplex quantitative polymerase chain reaction (RT-mqPCR) after the precipitation of nucleic acids with PEG 8,000 and RNA isolation with TRIzol™ Reagent. The number of copies of the gene encoding SARS-CoV-2 nucleocapsid (N1) per liter of wastewater was compared with the number of officially registered COVID-19 cases in Prague. Although the data obtained by sampling wastewater from the major Prague sewers were more consistent than those obtained from the small sewers, the correlation between wastewater-based and clinical-testing data was also good for the residential areas with more than 7,000 registered inhabitants. It was shown that monitoring SARS-CoV-2 RNA in wastewater sampled from small sewers could identify isolated occurrences of COVID-19-positive cases in local neighborhoods. This can be very valuable while tracking COVID-19 hotspots within large cities.
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Affiliation(s)
- Kamila Zdenkova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Czechia.
| | - Jana Bartackova
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Eliska Cermakova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Czechia
| | - Katerina Demnerova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Czechia
| | - Alzbeta Dostalkova
- Department of Biotechnology, University of Chemistry and Technology Prague, Czechia
| | - Vaclav Janda
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Jiri Jarkovsky
- Institute of Health Information and Statistics of the Czech Republic, Czechia
| | - Marco Antonio Lopez Marin
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | | | - Michaela Rumlova
- Department of Biotechnology, University of Chemistry and Technology Prague, Czechia
| | - Jana Rihova Ambrozova
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Klara Skodakova
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | | | - Petr Sykora
- Prazske vodovody a kanalizace, a.s., Czechia
| | - Dana Vejmelkova
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Jiri Wanner
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Jan Bartacek
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
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19
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Zdenkova K, Bartackova J, Cermakova E, Demnerova K, Dostalkova A, Janda V, Jarkovsky J, Lopez Marin MA, Novakova Z, Rumlova M, Ambrozova JR, Skodakova K, Swierczkova I, Sykora P, Vejmelkova D, Wanner J, Bartacek J. Monitoring COVID-19 spread in Prague local neighborhoods based on the presence of SARS-CoV-2 RNA in wastewater collected throughout the sewer network. WATER RESEARCH 2022; 216:118343. [PMID: 35358873 PMCID: PMC8936391 DOI: 10.1016/j.watres.2022.118343] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 05/12/2023]
Abstract
Many reports have documented that the presence of SARS-CoV-2 RNA in the influents of municipal wastewater treatment plants (WWTP) correlates with the actual epidemic situation in a given city. However, few data have been reported thus far on measurements upstream of WWTPs, i.e. throughout the sewer network. In this study, the monitoring of the presence of SARS-CoV-2 RNA in Prague wastewater was carried out at selected locations of the Prague sewer network from August 2020 through May 2021. Various locations such as residential areas of various sizes, hospitals, city center areas, student dormitories, transportation hubs (airport, bus terminal), and commercial areas were monitored together with four of the main Prague sewers. The presence of SARS-CoV-2 RNA was determined by reverse transcription - multiplex quantitative polymerase chain reaction (RT-mqPCR) after the precipitation of nucleic acids with PEG 8,000 and RNA isolation with TRIzol™ Reagent. The number of copies of the gene encoding SARS-CoV-2 nucleocapsid (N1) per liter of wastewater was compared with the number of officially registered COVID-19 cases in Prague. Although the data obtained by sampling wastewater from the major Prague sewers were more consistent than those obtained from the small sewers, the correlation between wastewater-based and clinical-testing data was also good for the residential areas with more than 7,000 registered inhabitants. It was shown that monitoring SARS-CoV-2 RNA in wastewater sampled from small sewers could identify isolated occurrences of COVID-19-positive cases in local neighborhoods. This can be very valuable while tracking COVID-19 hotspots within large cities.
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Affiliation(s)
- Kamila Zdenkova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Czechia.
| | - Jana Bartackova
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Eliska Cermakova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Czechia
| | - Katerina Demnerova
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Czechia
| | - Alzbeta Dostalkova
- Department of Biotechnology, University of Chemistry and Technology Prague, Czechia
| | - Vaclav Janda
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Jiri Jarkovsky
- Institute of Health Information and Statistics of the Czech Republic, Czechia
| | - Marco Antonio Lopez Marin
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | | | - Michaela Rumlova
- Department of Biotechnology, University of Chemistry and Technology Prague, Czechia
| | - Jana Rihova Ambrozova
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Klara Skodakova
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | | | - Petr Sykora
- Prazske vodovody a kanalizace, a.s., Czechia
| | - Dana Vejmelkova
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Jiri Wanner
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Jan Bartacek
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
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20
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Nelson J, Lu A, Maestre J, Palmer E, Jarma D, Kinney K, Grubesic T, Kirisits M. Space-time analysis of COVID-19 cases and SARS-CoV-2 wastewater loading: A geodemographic perspective. Spat Spatiotemporal Epidemiol 2022; 42:100521. [PMID: 35934330 PMCID: PMC9142176 DOI: 10.1016/j.sste.2022.100521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/05/2022]
Abstract
Severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2) continues to effect communities across the world. One way to combat these effects is to enhance our collective ability to remotely monitor community spread. Monitoring SARS-CoV-2 in wastewater is one approach that enables researchers to estimate the total number of infected people in a region; however, estimates are often made at the sewershed level which may mask the geographic nuance required for targeted interdiction efforts. In this work, we utilize an apportioning method to compare the spatial and temporal trends of daily case count with the temporal pattern of viral load in the wastewater at smaller units of analysis within Austin, TX. We find different lag-times between wastewater loading and case reports. Daily case reports for some locations follow the temporal trend of viral load more closely than others. These findings are then compared to socio-demographic characteristics across the study area.
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21
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Holm RH, Nagarkar M, Yeager RA, Talley D, Chaney AC, Rai JP, Mukherjee A, Rai SN, Bhatnagar A, Smith T. Surveillance of RNase P, PMMoV, and CrAssphage in wastewater as indicators of human fecal concentration across urban sewer neighborhoods, Kentucky. FEMS MICROBES 2022; 3:1-12. [PMID: 37228897 PMCID: PMC10117713 DOI: 10.1093/femsmc/xtac003] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/24/2021] [Accepted: 01/25/2022] [Indexed: 09/03/2023] Open
Abstract
Wastewater surveillance has been widely used as a supplemental method to track the community infection levels of severe acute respiratory syndrome coronavirus 2. A gap exists in standardized reporting for fecal indicator concentrations, which can be used to calibrate the primary outcome concentrations from wastewater monitoring for use in epidemiological models. To address this, measurements of fecal indicator concentration among wastewater samples collected from sewers and treatment centers in four counties of Kentucky (N = 650) were examined. Results from the untransformed wastewater data over 4 months of sampling indicated that the fecal indicator concentration of human ribonuclease P (RNase P) ranged from 5.1 × 101 to 1.15 × 106 copies/ml, pepper mild mottle virus (PMMoV) ranged from 7.23 × 103 to 3.53 × 107 copies/ml, and cross-assembly phage (CrAssphage) ranged from 9.69 × 103 to 1.85 × 108 copies/ml. The results showed both regional and temporal variability. If fecal indicators are used as normalization factors, knowing the daily sewer system flow of the sample location may matter more than rainfall. RNase P, while it may be suitable as an internal amplification and sample adequacy control, has less utility than PMMoV and CrAssphage as a fecal indicator in wastewater samples when working at different sizes of catchment area. The choice of fecal indicator will impact the results of surveillance studies using this indicator to represent fecal load. Our results contribute broadly to an applicable standard normalization factor and assist in interpreting wastewater data in epidemiological modeling and monitoring.
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Affiliation(s)
- R H Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA
| | - M Nagarkar
- Center for Environmental Solutions and Emergency Response, United States Environmental Protection Agency, Cincinnati, OH 45220, USA
| | - R A Yeager
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA
- Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, USA
| | - D Talley
- Louisville/Jefferson County Metropolitan Sewer District, Morris Forman Water Quality Treatment Center, 4522 Algonquin Parkway, Louisville, KY 40211, USA
| | - A C Chaney
- Sanitation District No. 1 of Northern Kentucky, 1045 Eaton Dr., Ft. Wright, Kentucky 41017, USA
| | - J P Rai
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
| | - A Mukherjee
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
| | - S N Rai
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
- Brown Cancer Center, School of Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
- Center for Integrative Environmental Health Sciences, 500 S. Preston St., Suite 1319, Louisville, KY 40202, USA
| | - A Bhatnagar
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA
| | - T Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA
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22
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LaJoie AS, Holm RH, Anderson LB, Ness HD, Smith T. Nationwide public perceptions regarding the acceptance of using wastewater for community health monitoring in the United States. PLoS One 2022. [PMID: 36219594 DOI: 10.1101/2022.03.16.22272262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
To assess the levels of infection across communities during the coronavirus disease 2019 pandemic, researchers have measured severe acute respiratory syndrome coronavirus 2 RNA in feces dissolved in sewer water. This activity is colloquially known as sewer monitoring and is referred to as wastewater-based epidemiology in academic settings. Although global ethical principles have been described, sewer monitoring is unregulated for health privacy protection when used for public health surveillance in the United States. This study used Qualtrics XM, a national research panel provider, to recruit participants to answer an online survey. Respondents (N = 3,083) answered questions about their knowledge, perceptions of what is to be monitored, where monitoring should occur, and privacy concerns related to sewer monitoring as a public health surveillance tool. Furthermore, a privacy attitude questionnaire was used to assess the general privacy boundaries of respondents. Participants were more likely to support monitoring for diseases (92%), environmental toxins (92%), and terrorist threats (88%; e.g., anthrax). Two-third of the respondents endorsed no prohibition on location sampling scale (e.g., monitoring single residence to entire community was acceptable); the most common location category respondents wanted to prohibit sampling was at personal residences. Sewer monitoring is an emerging technology, and our study sheds light on perceptions that could benefit from educational programs in areas where public acceptance is comparatively lower. Respondents clearly communicated guard rails for sewer monitoring, and public opinion should inform future policy, application, and regulation measures.
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Affiliation(s)
- A Scott LaJoie
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Rochelle H Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Lauren B Anderson
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Heather D Ness
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
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23
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Rouchka EC, Chariker JH, Saurabh K, Waigel S, Zacharias W, Zhang M, Talley D, Santisteban I, Puccio M, Moyer S, Holm RH, Yeager RA, Sokoloski KJ, Fuqua J, Bhatnagar A, Smith T. The Rapid Assessment of Aggregated Wastewater Samples for Genomic Surveillance of SARS-CoV-2 on a City-Wide Scale. Pathogens 2021; 10:1271. [PMID: 34684220 PMCID: PMC8541652 DOI: 10.3390/pathogens10101271] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/03/2021] [Accepted: 09/28/2021] [Indexed: 01/08/2023] Open
Abstract
Throughout the course of the ongoing SARS-CoV-2 pandemic there has been a need for approaches that enable rapid monitoring of public health using an unbiased and minimally invasive means. A major way this has been accomplished is through the regular assessment of wastewater samples by qRT-PCR to detect the prevalence of viral nucleic acid with respect to time and location. Further expansion of SARS-CoV-2 wastewater monitoring efforts to include the detection of variants of interest/concern through next-generation sequencing has enhanced the understanding of the SARS-CoV-2 outbreak. In this report, we detail the results of a collaborative effort between public health and metropolitan wastewater management authorities and the University of Louisville to monitor the SARS-CoV-2 pandemic through the monitoring of aggregate wastewater samples over a period of 28 weeks. Through the use of next-generation sequencing approaches the polymorphism signatures of Variants of Concern/Interest were evaluated to determine the likelihood of their prevalence within the community on the basis of their relative dominance within sequence datasets. Our data indicate that wastewater monitoring of water quality treatment centers and smaller neighborhood-scale catchment areas is a viable means by which the prevalence and genetic variation of SARS-CoV-2 within a metropolitan community of approximately one million individuals may be monitored, as our efforts detected the introduction and emergence of variants of concern in the city of Louisville. Importantly, these efforts confirm that regional emergence and spread of variants of interest/concern may be detected as readily in aggregate wastewater samples as compared to the individual wastewater sheds. Furthermore, the information gained from these efforts enabled targeted public health efforts including increased outreach to at-risk communities and the deployment of mobile or community-focused vaccination campaigns.
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Affiliation(s)
- Eric C. Rouchka
- Department of Biochemistry and Molecular Genetics, University of Louisville, 323 E. Chestnut St., Louisville, KY 40202, USA;
- KY INBRE Bioinformatics Core, University of Louisville, 522 E. Gray St., Louisville, KY 40202, USA;
| | - Julia H. Chariker
- KY INBRE Bioinformatics Core, University of Louisville, 522 E. Gray St., Louisville, KY 40202, USA;
| | - Kumar Saurabh
- Brown Cancer Center, University of Louisville, 530 S. Jackson St., Louisville, KY 40202, USA;
| | - Sabine Waigel
- Department of Medicine, University of Louisville, 530 S. Jackson St., Louisville, KY 40402, USA; (S.W.); (W.Z.)
| | - Wolfgang Zacharias
- Department of Medicine, University of Louisville, 530 S. Jackson St., Louisville, KY 40402, USA; (S.W.); (W.Z.)
| | - Mei Zhang
- Department of Neuroscience, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA;
| | - Daymond Talley
- Louisville/Jefferson County Metropolitan Sewer District, Morris Forman Water Quality Treatment Center, 4522 Algonquin Parkway, Louisville, KY 40211, USA;
| | - Ian Santisteban
- Department of Pharmacology and Toxicology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA;
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
| | - Madeline Puccio
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA; (M.P.); (R.H.H.); (R.A.Y.); (A.B.); (T.S.)
| | - Sarah Moyer
- Department of Health Management and System Sciences, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, USA;
- Department of Public Health and Wellness, Louisville Metro Government, 400 E. Gray St., Louisville, KY 40202, USA
| | - Rochelle H. Holm
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA; (M.P.); (R.H.H.); (R.A.Y.); (A.B.); (T.S.)
| | - Ray A. Yeager
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA; (M.P.); (R.H.H.); (R.A.Y.); (A.B.); (T.S.)
- Department of Environmental and Occupational Health Sciences, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, USA
| | - Kevin J. Sokoloski
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
- Department of Microbiology and Immunology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
| | - Joshua Fuqua
- Department of Pharmacology and Toxicology, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA;
- Center for Predictive Medicine, University of Louisville, 505 S. Hancock St., Louisville, KY 40202, USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA; (M.P.); (R.H.H.); (R.A.Y.); (A.B.); (T.S.)
| | - Ted Smith
- Christina Lee Brown Envirome Institute, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA; (M.P.); (R.H.H.); (R.A.Y.); (A.B.); (T.S.)
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