Wastewater-based epidemiology: current uses and future opportunities as a public health surveillance tool

O’Keeffe, Juliette

doi:10.5864/d2021-015

Cited by 45 publications

(46 citation statements)

References 69 publications

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“…These studies describe a range of sample concentration and viral RNA recovery approaches, followed by RT-qPCR to determine the viral load. These proof-of-concept studies indicate that wastewater monitoring can be used as an early detection tool for health autorities 20 .…”

Section: Introductionmentioning

confidence: 82%

National Scale Real-Time Surveillance of Sars-Cov-2 Variants Dynamics by Wastewater Monitoring in Israel

Bar-Or

Indenbaum

Weil³

et al. 2021

Preprint

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In this report, we describe a national-scale monitoring of the SARS-COV-2 (SC-2) variant dynamics in Israel, using multiple-time sampling of twelve wastewater treatment plants. We used a combination of inclusive and selective quantitative PCR assays that specifically identify variants A19 or B.1.1.7 and tested each sample for the presence and relative viral RNA load of each variant. We show that between December-2020 and March-2021, a complete shift in the SC-2 variant circulation was observed, where the B.1.1.7 replaced the A19 in all examined test points. We further show that the normalized viral load (NVL) values and the average new cases per week reached a peak in January 2021, and then decreased gradually in almost all test points, in parallel with the progression of the national vaccination campaign, during February-March 2021. This study demonstrates the importance of monitoring SC-2 variant dynamics on a national scale through wastewater sampling. It also provides a proof-of-concept methodology for continuous surveillance by using a combination of inclusive and selective PCR tests, which is far more amendable for high throughput monitoring compared with sequencing. This approach may be useful for real-time dynamics surveillance of current and future variants, such as the Omicron (BA.1) variant.

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Section: Introductionmentioning

confidence: 82%

National Scale Real-Time Surveillance of Sars-Cov-2 Variants Dynamics by Wastewater Monitoring in Israel

Bar-Or

Indenbaum

Weil³

et al. 2021

Preprint

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“…WBE has the potential to become a powerful public health tool, as evidenced by the integral role it has played in the recent COVID-19 pandemic. 23 However, as highlighted by both our own conversations with New Zealand public health authorities and in several recent commentaries in other jurisdictions, 23 , 29 public health authorities often need guidance when designing a WBE program to ensure that a ) WBE is a suitable option for their chosen HD with regard to alternative monitoring options and the actionability of the data it will generate and b ) they select a suitable biomarker for monitoring. In this commentary we present a framework to be used by public health authorities, or indeed other organizations seeking guidance on WBE, for evaluating the suitability of HDs for WBE and selection of appropriate biomarkers for monitoring.…”

Section: Discussionmentioning

confidence: 99%

“… 23 and O’Keeffe. 29 Although these sit outside of the evaluation framework presented, they are important in ensuring that the program is fit for purpose and appropriate. For example, what level of detail is required to inform decision-making (e.g., detection limits, frequency of sampling, granularity of subcatchments); what are the resource needs (e.g., is there existing sampling in place that can be leveraged, what are the costs, is there sufficient expertise and capacity); how will the data be managed (e.g., who will have access, how will it be stored); how will the data be used (e.g., how will it be analyzed, do action limits needs to be set); what stakeholders need to be involved; and how will the results be communicated or reported?…”

Section: Discussionmentioning

confidence: 99%

“…Given that undertaking WBE will divert some of those resources away from other public health activities, consideration must be given to the suitability of a HD for WBE, the quality and strength of the data that would be obtained, and how it would be used to inform a public health response to ensure that the implementation of WBE is warranted and appropriate. 29 …”

Section: Introductionmentioning

confidence: 99%

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A Framework for Public Health Authorities to Evaluate Health Determinants for Wastewater-Based Epidemiology

Eaton

Coxon

Pattis

et al. 2022

Environ Health Perspect

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Background: Wastewater-based epidemiology (WBE) is rapidly developing as a powerful public health tool. It can provide information about a wide range of health determinants (HDs), including community exposure to environmental hazards, trends in consumption of licit and illicit substances, spread of infectious diseases, and general community health. As such, the list of possible candidate HDs for WBE is almost limitless. Consequently, a means to evaluate and prioritize suitable candidates for WBE is useful, particularly for public health authorities, who often face resource constraints. Objectives: We have developed a framework to assist public health authorities to decide what HDs may be appropriate for WBE and what biomarkers could be used. This commentary reflects the experience of the authors, who work at the interface of research and public health implementation. Discussion: To be suitable for WBE, a candidate HD should address a public health or scientific issue that would benefit from better understanding at the population level. For HDs where information on individual exposures or stratification by population subgroups is required, WBE is less suitable. Where other methodologies are already used to monitor the candidate HD, consideration must be given to whether WBE could provide better or complementary information to the current approach. An essential requirement of WBE is a biomarker specific for the candidate HD. A biomarker in this context refers to any human-excreted chemical or biological that could act as an indicator of consumption or exposure to an environmental hazard or of the human health state. Suitable biomarkers should meet several criteria outlined in this commentary, which requires background knowledge for both the biomarker and the HD. An evaluation tree summarizing key considerations for public health authorities when assessing the suitability of candidate HDs for WBE and an example evaluation are presented. https://doi.org/10.1289/EHP11115

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Section: Introductionmentioning

confidence: 88%

National Scale Real-Time Surveillance of SARS-CoV-2 Variants Dynamics by Wastewater Monitoring in Israel

Bar-Or

Indenbaum

Weil

et al. 2022

Viruses

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In this report, we describe a national-scale monitoring of the SARS-CoV-2 (SC-2) variant dynamics in Israel, using multiple-time sampling of 13 wastewater treatment plants. We used a combination of inclusive and selective quantitative PCR assays that specifically identify variants A19/A20 or B.1.1.7 and tested each sample for the presence and relative viral RNA load of each variant. We show that between December 2020 and March 2021, a complete shift in the SC-2 variant circulation was observed, where the B.1.1.7 replaced the A19 in all examined test points. We further show that the normalized viral load (NVL) values and the average new cases per week reached a peak in January 2021 and then decreased gradually in almost all test points, in parallel with the progression of the national vaccination campaign, during February–March 2021. This study demonstrates the importance of monitoring SC-2 variant by using a combination of inclusive and selective PCR tests on a national scale through wastewater sampling, which is far more amendable for high-throughput monitoring compared with sequencing. This approach may be useful for real-time dynamics surveillance of current and future variants, such as the Omicron (BA.1, BA.2) and other variants.

show abstract

Wastewater-based epidemiology: current uses and future opportunities as a public health surveillance tool

Cited by 45 publications

References 69 publications

National Scale Real-Time Surveillance of Sars-Cov-2 Variants Dynamics by Wastewater Monitoring in Israel

National Scale Real-Time Surveillance of Sars-Cov-2 Variants Dynamics by Wastewater Monitoring in Israel

A Framework for Public Health Authorities to Evaluate Health Determinants for Wastewater-Based Epidemiology

National Scale Real-Time Surveillance of SARS-CoV-2 Variants Dynamics by Wastewater Monitoring in Israel

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