Wastewater surveillance beyond COVID-19: a ranking system for communicable disease testing in the tri-county Detroit area, Michigan, USA

Abstract

IntroductionThroughout the coronavirus disease 2019 (COVID-19) pandemic, wastewater surveillance has been utilized to monitor the disease in the United States through routine national, statewide, and regional monitoring projects. A significant canon of evidence was produced showing that wastewater surveillance is a credible and effective tool for disease monitoring. Hence, the application of wastewater surveillance can extend beyond monitoring SARS-CoV-2 to encompass a diverse range of emerging diseases. This article proposed a ranking system for prioritizing reportable communicable diseases (CDs) in the Tri-County Detroit Area (TCDA), Michigan, for future wastewater surveillance applications at the Great Lakes Water Authority's Water Reclamation Plant (GLWA's WRP).MethodsThe comprehensive CD wastewater surveillance ranking system (CDWSRank) was developed based on 6 binary and 6 quantitative parameters. The final ranking scores of CDs were computed by summing the multiplication products of weighting factors for each parameter, and then were sorted based on decreasing priority. Disease incidence data from 2014 to 2021 were collected for the TCDA. Disease incidence trends in the TCDA were endowed with higher weights, prioritizing the TCDA over the state of Michigan.ResultsDisparities in incidences of CDs were identified between the TCDA and state of Michigan, indicating epidemiological differences. Among 96 ranked CDs, some top ranked CDs did not present relatively high incidences but were prioritized, suggesting that such CDs require significant attention by wastewater surveillance practitioners, despite their relatively low incidences in the geographic area of interest. Appropriate wastewater sample concentration methods are summarized for the application of wastewater surveillance as per viral, bacterial, parasitic, and fungal pathogens.DiscussionThe CDWSRank system is one of the first of its kind to provide an empirical approach to prioritize CDs for wastewater surveillance, specifically in geographies served by centralized wastewater collection in the area of interest. The CDWSRank system provides a methodological tool and critical information that can help public health officials and policymakers allocate resources. It can be used to prioritize disease surveillance efforts and ensure that public health interventions are targeted at the most potentially urgent threats. The CDWSRank system can be easily adopted to geographical locations beyond the TCDA.

Strengthening Pathogen and Antimicrobial Resistance Surveillance by Environmental Monitoring in Sub-Saharan Africa: A Stakeholder Survey

“…For pathogens other than the waterborne transmission route, respondents in this study prioritized SARS-CoV-2, influenza A&B, measles and rubella, and Mycobacterium tuberculosis. Of these, the existing use cases of WES have already been reported for SARS-CoV-2 [70][71][72][73][74], influenza A&B [75][76][77][78], and dengue virus [33,79,80]. Measles and rubella, viral diseases, transmitted through respiratory and airborne droplets, are relatively less often monitored in wastewater [15,80].…”

“…Of these, the existing use cases of WES have already been reported for SARS-CoV-2 [70][71][72][73][74], influenza A&B [75][76][77][78], and dengue virus [33,79,80]. Measles and rubella, viral diseases, transmitted through respiratory and airborne droplets, are relatively less often monitored in wastewater [15,80]. Many infection cases of both measles and rubella may go asymptomatic, and these are detected in urine, so these have high potentiality to be monitored through WES.…”

Wastewater surveillance for bacterial targets: current challenges and future goals

“…Third, will the data be useful to inform specific public health actions? An additional ranking system was recently published by Gentry et al ( 24 ). This considers reportable diseases, transmissibility, local case rates for the Detroit-area, and analytical feasibility to produce a numeric score ( 24 ).…”

“…An additional ranking system was recently published by Gentry et al ( 24 ). This considers reportable diseases, transmissibility, local case rates for the Detroit-area, and analytical feasibility to produce a numeric score ( 24 ). Diseases with higher scores should have higher priority.…”

“…However, this was developed specifically for the Detroit-area. Moving forward, increasing adoption of both the NASEM criteria and ranking systems like the one produced by Gentry et al ( 24 ) will allow for improved resource allocation toward infectious disease targets of public health value. Research efforts to optimize sampling, concentration, and extraction methods should be focused on these targets to ensure successful implementation by public health professionals.…”