Wastewater-based surveillance as a tool for public health action: SARS-CoV-2 and beyond

Abstract

SUMMARY Wastewater-based surveillance (WBS) has undergone dramatic advancement in the context of the coronavirus disease 2019 (COVID-19) pandemic. The power and potential of this platform technology were rapidly realized when it became evident that not only did WBS-measured SARS-CoV-2 RNA correlate strongly with COVID-19 clinical disease within monitored populations but also, in fact, it functioned as a leading indicator. Teams from across the globe rapidly innovated novel approaches by which wastewater could be collected from diverse sewersheds ranging from wastewater treatment plants (enabling community-level surveillance) to more granular locations including individual neighborhoods and high-risk buildings such as long-term care facilities (LTCF). Efficient processes enabled SARS-CoV-2 RNA extraction and concentration from the highly dilute wastewater matrix. Molecular and genomic tools to identify, quantify, and characterize SARS-CoV-2 and its various variants were adapted from clinical programs and applied to these mixed environmental systems. Novel data-sharing tools allowed this information to be mobilized and made immediately available to public health and government decision-makers and even the public, enabling evidence-informed decision-making based on local disease dynamics. WBS has since been recognized as a tool of transformative potential, providing near-real-time cost-effective, objective, comprehensive, and inclusive data on the changing prevalence of measured analytes across space and time in populations. However, as a consequence of rapid innovation from hundreds of teams simultaneously, tremendous heterogeneity currently exists in the SARS-CoV-2 WBS literature. This manuscript provides a state-of-the-art review of WBS as established with SARS-CoV-2 and details the current work underway expanding its scope to other infectious disease targets.

Targeted Sequencing of CTX-M Alleles in Seattle Area Wastewater

“…Surveilling hospital wastewater could aid in understanding the diversity of AMR and potentially inform targeted, clinical interventions. 23,48 In areas with untreated wastewater, such as LMICs, understanding the discharged wastewater ARG alleles can help with public health interventions to reduce proliferation or exposure in the environment. 49,50 In addition, by characterizing mutation hotspots within ARGs, we can potentially estimate mutations that could result in different phenotypic resistance.…”

Enterococci, Van Gene-Carrying Enterococci, and Vancomycin Concentrations in the Influent of a Wastewater Treatment Plant in Southeast Germany

“…Investigation of wastewater is a useful way to follow the excretion of fecal bacteria, viruses, and parasites at the population level. As confirmed in an exemplary manner during the SARS-CoV-2 pandemic, wastewater monitoring is a helpful tool to evaluate the epidemiological situation in the catchment of treatment plants and to characterize the evolution processes of microorganisms [ 1 ]. This includes the presence of resistance determinants among fecal bacteria posing an increasing risk for patients, as well as the wastewater facilitating the dissemination of resistant species and their antibiotic-resistance genes in the aqueous environment [ 2 , 3 ].…”