Norovirus detection in wastewater and its correlation with human gastroenteritis: a systematic review and meta-analysis

Abstract

Norovirus (NoV) is a major cause of sporadic cases and outbreaks of acute gastroenteritis (AGE), thereby imposing threat to health globally. It is unclear how quantitation of wastewater NoV reflects the incidence of human AGE infections; therefore, we conducted this systematic review and meta-analysis of published NoV wastewater surveillance studies. A literature search was performed, and all studies on NoV wastewater surveillance were identified. Quantitative results were evaluated. The results showed that the overall detection rate of NoV in wastewater was 82.10% (95% confidence interval [CI]: 74.22–89.92%); NoV concentration was statistically significant in terms of season ( P < 0.001), with higher concentration in spring and winter. There were positive correlations between NoV GII concentration in wastewater and GII AGE cases ( r s = 0.51, 95% CI: 0.18–0.74, I 2 = 0%), total AGE cases ( r s = 0.40, 95% CI: 0.15–0.61, I 2 = 23%) and NoV outbreaks ( r s = 0.47, 95% CI: 0.30–0.62, I 2 = 0%). Results of cross-correlation analysis of partial data indicated that variations in GII concentration were consistent with or ahead of those in the number of AGE cases. The diversity of NoV genotypes in wastewater was elucidated, and the dominant strains in wastewater showed a consistent temporal distribution with those responsible for human AGE. Our study demonstrated the potential association of NoV detected in wastewater with AGE infections, and further studies are needed to confirm this conclusion. Supplementary Information The online version contains supplementary material available at 10.1007/s11356-021-18202-x.

Expanding the Pathogen Panel in Wastewater Epidemiology to Influenza and Norovirus

“…Correlation between viral loads in wastewater and inpatients were significant for both, IAV and NoV GII, which is in accordance with previous studies [ 9 , 10 , 11 , 12 ]. Inclusion of the GI wastewater signal reduced the correlation coefficient which indicates a difference in hospitalization rates between GII and GI.…”

“…Cross-correlation analysis indicated that the wastewater signal coincided with inpatient numbers for IAV und NoV GII. Huang et al (2022) [ 10 ] reported similar results for NoV GII comparing wastewater data with cases and outbreaks of acute gastroenteritis. Kazama et al (2017) [ 9 ] reported similar results for NoV in comparison with clinical cases.…”

“…Wastewater-based epidemiology (WBE) is a powerful tool for monitoring the spread of viral pathogens within a population connected to a sewage system, as shown during the COVID-19 pandemic [ 1 , 2 , 3 , 4 , 5 ]. Viruses such as poliovirus [ 6 , 7 ], hepatitis E virus [ 8 ], norovirus (NoV) [ 9 , 10 ], influenza virus [ 11 , 12 ], and many more have already been detected [ 13 ] and monitored in wastewater. In contrast to traditional individual-level testing, WBE offers several advantages for the cost-efficient early detection of local or regional outbreaks and long-term monitoring of pathogens at community level [ 14 ].…”

Analysis of metatranscriptomic methods to enable wastewater-based biosurveillance of all infectious diseases

“…While metatranscriptomics is able to detect eukaryotic, bacterial, and viral pathogens, several studies have shown that the untargeted methods available are not adequate to detect unknown pathogens with small genomes such as viruses on a large scale at a reasonable cost ( 20 , 24 , 32 , 33 ). Surveillance of viruses in wastewater has been mainly conducted using targeted approaches such as amplicon sequencing for particular pathogen genomes such as SARS-CoV-2 or norovirus ( 4 , 5 , 17 , 20 , 24 , 34 ) or through use of viral concentration methods which remove all bacteria and eukaryotic cells prior to sequencing, thereby removing information on other potential pathogens ( 3 , 35 ). Furthermore, wastewater is comprised of intact as well as cellular debris, and therefore, filtration and concentration methods do not enrich enough for viruses to enable consistent detection by non-targeted sequencing methods ( 20 , 33 ).…”

Wastewater Surveillance for Communicable Diseases

“…After a confirmed case of polio was detected in New York State in late 2022, wastewater surveillance revealed community transmission of poliovirus in the surrounding counties. 25 Wastewater surveillance has also been used to detect the presence of rotavirus, 26 norovirus, 27 and Mpox. 28…”