Expanding the Pathogen Panel in Wastewater Epidemiology to Influenza and Norovirus

Abstract

Since the start of the 2019 pandemic, wastewater-based epidemiology (WBE) has proven to be a valuable tool for monitoring the prevalence of SARS-CoV-2. With methods and infrastructure being settled, it is time to expand the potential of this tool to a wider range of pathogens. We used over 500 archived RNA extracts from a WBE program for SARS-CoV-2 surveillance to monitor wastewater from 11 treatment plants for the presence of influenza and norovirus twice a week during the winter season of 2021/2022. Extracts were analyzed via digital PCR for influenza A, influenza B, norovirus GI, and norovirus GII. Resulting viral loads were normalized on the basis of NH4-N. Our results show a good applicability of ammonia-normalization to compare different wastewater treatment plants. Extracts originally prepared for SARS-CoV-2 surveillance contained sufficient genomic material to monitor influenza A, norovirus GI, and GII. Viral loads of influenza A and norovirus GII in wastewater correlated with numbers from infected inpatients. Further, SARS-CoV-2 related non-pharmaceutical interventions affected subsequent changes in viral loads of both pathogens. In conclusion, the expansion of existing WBE surveillance programs to include additional pathogens besides SARS-CoV-2 offers a valuable and cost-efficient possibility to gain public health information.

A systematic review of influenza virus in water environments across human, poultry, and wild bird habitats

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Estimating actual SARS-CoV-2 infections from secondary data

“…While this study has a focus on SARS-CoV-2 we also wish to emphasize its relevance for other viral diseases, e.g., Noro- or Influenzavirus 64 . Early warnings and epidemiological predictions based on sound models also for these viruses and others may help in local, regional or national prevention.…”

Simultaneous detection and quantification of multiple pathogen targets in wastewater

“…As SARS-CoV-2 surveillance in wastewater reaches scale [7,25,43], detection and quantification of other pathogens has been proposed. Researchers have expanded on wastewater monitoring to focus increased surveillance on other respiratory viruses such as human influenza and rhinovirus [44], norovirus [45], or as an outbreak detection tool for influenza, [46] and are also considering other emerging infections such as monkeypox. [47] .…”