Evaluation of wastewater surveillance for SARS-CoV-2 in Massachusetts correctional facilities, 2020–2022

Klevens, R. Monina; Young, Caroline; Olesen, Scott W.; Osinski, Anthony; Church, Daniel; Muten, Jennifer; Chou, Lori; Segal, Tami; Cranston, Kevin

doi:10.3389/frwa.2023.1083316

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…Schools were another congregate setting where wastewater surveillance demonstrated utility in identifying and potentially mitigating SARS-CoV-2 infection [ 28 , 29 ]. Correctional settings have also used and evaluated wastewater surveillance [ 30 ], and former inmates have voiced a preference for wastewater surveillance over individual testing for SARS-CoV-2 [ 31 ]. Many of the lessons learned from this evaluation of wastewater surveillance at LTCFs may apply to wastewater surveillance in other facility-level settings.…”

Section: Discussionmentioning

confidence: 99%

Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation

Keck¹,

Lindner²,

Liversedge³

et al. 2023

JMIR Public Health Surveill

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Background Wastewater surveillance provided early indication of COVID-19 in US municipalities. Residents of long-term care facilities (LTCFs) experienced disproportionate morbidity and mortality early in the COVID-19 pandemic. We implemented LTCF building-level wastewater surveillance for SARS-CoV-2 at 6 facilities in Kentucky to provide early warning of SARS-CoV-2 in populations considered vulnerable. Objective This study aims to evaluate the performance of wastewater surveillance for SARS-CoV-2 at LTCFs in Kentucky. Methods We conducted a mixed methods evaluation of wastewater surveillance following Centers for Disease Control and Prevention (CDC) guidelines for evaluating public health surveillance systems. Evaluation steps in the CDC guidelines were engaging stakeholders, describing the surveillance system, focusing the evaluation design, gathering credible evidence, and generating conclusions and recommendations. We purposively recruited stakeholders for semistructured interviews and undertook thematic content analysis of interview data. We integrated wastewater, clinical testing, and process data to characterize or calculate 7 surveillance system performance attributes (simplicity, flexibility, data quality, sensitivity and positive predictive value [PPV], timeliness, representativeness, and stability). Results We conducted 8 stakeholder interviews. The surveillance system collected wastewater samples (N=811) 2 to 4 times weekly at 6 LTCFs in Kentucky from March 2021 to February 2022. Synthesis of credible evidence indicated variable surveillance performance. Regarding simplicity, surveillance implementation required moderate human resource and technical capacity. Regarding flexibility, the system efficiently adjusted surveillance frequency and demonstrated the ability to detect additional pathogens of interest. Regarding data quality, software identified errors in wastewater sample metadata entry (110/3120, 3.53% of fields), technicians identified polymerase chain reaction data issues (140/7734, 1.81% of reactions), and staff entered all data corrections into a log. Regarding sensitivity and PPV, using routine LTCF SARS-CoV-2 clinical testing results as the gold standard, a wastewater SARS-CoV-2 signal of >0 RNA copies/mL was 30.6% (95% CI 24.4%-36.8%) sensitive and 79.7% (95% CI 76.4%-82.9%) specific for a positive clinical test at the LTCF. The PPV of the wastewater signal was 34.8% (95% CI 27.9%-41.7%) at >0 RNA copies/mL and increased to 75% (95% CI 60%-90%) at >250 copies/mL. Regarding timeliness, stakeholders received surveillance data 24 to 72 hours after sample collection, with delayed reporting because of the lack of weekend laboratory staff. Regarding representativeness, stakeholders identified challenges delineating the population contributing to LTCF wastewater because of visitors, unknown staff toileting habits, and the use of adult briefs by some residents preventing their waste from entering the sewer system. Regarding stability, the reoccurring cost to conduct 1 day of wastewater surveillance at 1 facility was approximately US $144.50, which included transportation, labor, and materials expenses. Conclusions The LTCF wastewater surveillance system demonstrated mixed performance per CDC criteria. Stakeholders found surveillance feasible and expressed optimism regarding its potential while also recognizing challenges in interpreting and acting on surveillance data.

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Section: Discussionmentioning

confidence: 99%

Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation

Keck¹,

Lindner²,

Liversedge³

et al. 2023

JMIR Public Health Surveill

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“…Other work has found the building-level detection threshold of SARS-CoV-2 in wastewater down to 1 true positive case is possible. 20 But previous wastewater models have focused on estimating the numbers of infected individuals from a wastewater RNA concentration 6,13,21 ; where our model differs rather is in estimating at least one individual from a wastewater RNA concentrations to guide a facility population health response regardless of the number of cases. Because we know conditions of confinement were a concern during the COVID-19 pandemic 22,23 in terms of physical distancing and access to water, sanitation and hygiene facilities, it was additionally important but also unique for our model to consider the occupancy rate directly tied to both the clinical and wastewater concentrations.…”

Section: Sensitivitymentioning

confidence: 99%

“…10 There have been few examples of single or a few clusters of corrections facility testing alongside large community scale SARS-CoV-2 monitoring. [11][12][13] Corrections facilities are also unique from a health equity angle, as healthcare access and testing are universally available.…”

Section: Introductionmentioning

confidence: 99%

Projections of wastewater as an indicator of COVID-19 cases in corrections facilities: a modelling study

Han,

Linares,

Holm

et al. 2023

Preprint

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BackgroundAlthough prison facilities are not fully isolated from the communities they are located within, the majority of the population is confined and requires high levels of health vigilance and protection. This study sought to examine the dynamic relationship between facility level wastewater viral RNA concentration and probability of at least one positive COVID-19 case within the facility.MethodsThe study period was January 11, 2021 through May 12, 2023. Wastewater samples were collected and analyzed for SARS-CoV-2 (N1) and pepper mild mottle virus (PMMoV) three times per week across 14 prison facilities in Kentucky (USA). Confirmed positive clinical case reports were also provided. A hierarchical Bayesian spatial-temporal model with a latent lagged process was developed.FindingsWe modeled a facility-specific SARS-CoV-2 (N1) normalized by PMMoV wastewater ratio associated with at least one COVID-19 facility case with an 80% probability. The ratio differs among facilities. Across the 14 facilities, our model demonstrates an average capture rate of 94·95% via the N1/PMMoV threshold withpts≥ 0·5. However, it is noteworthy as theptsthreshold is set higher, such as at 0·9 or above, the model’s average capture rate reduces to 60%. This robust performance underscores the model’s effectiveness in accurately detecting the presence of positive COVID-19 cases of incarcerated people.InterpretationThe findings of this study provide a correction facility-specific threshold model for public health response based on frequent wastewater surveillance.

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“…Prisons are also often overcrowded, creating conditions that can facilitate COVID-19 transmission [9]. However, only one WBE study on SARS-CoV-2 in prisons has been reported [10] due to difficulties associated with access to prisons for researchers and the installation of sampling equipment [11].…”

Section: Introductionmentioning

confidence: 99%

Wastewater Surveillance of SARS-CoV-2 RNA in a Prison Facility

Thakali,

Shahin,

Sherchan

2024

Water

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Prison populations are unlikely to have access to prompt, effective medical care as the general population. Therefore, vaccination and effective surveillance systems have been recommended to mitigate coronavirus disease 2019 (COVID-19) transmission in prison settings. This pilot study aimed to assess the application of wastewater-based epidemiology (WBE) in a prison to act as an early warning tool for COVID-19 transmission. In this study, weekly wastewater samples (n = 21) were collected for 21 weeks from a prison facility in New Orleans, LA, USA, and analyzed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the results were compared with the number of confirmed cases during the same period. SARS-CoV-2 was concentrated using two methods and quantified via RT-qPCR using CDC N1 and N2 assays. Overall, SARS-CoV-2 was detected in eight samples (38%). An equal number of samples tested positive for SARS-CoV-2 using the two concentrating methods, indicating the effectiveness of both methods for building-scale WBE. Despite limited clinical testing in the studied prison facility, instances of SARS-CoV-2 detection in wastewater prior to the diagnosis of COVID-19 depict the potential use of wastewater surveillance in detecting the presence of early and averting outbreaks in asymptomatic COVID-19 patients.

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Evaluation of wastewater surveillance for SARS-CoV-2 in Massachusetts correctional facilities, 2020–2022

Cited by 4 publications

References 19 publications

Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation

Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation

Projections of wastewater as an indicator of COVID-19 cases in corrections facilities: a modelling study

Wastewater Surveillance of SARS-CoV-2 RNA in a Prison Facility

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