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do Nascimento MCA, Rosa CR, Demoliner M, Geraldini DB, Campos GRF, Quevedo DM, Miceli RN, Spilki FR, Araújo JP, Calmon MF, Rahal P. Epidemiological and Molecular Surveillance of Aichi Virus A at Different Stages of Sewage Treatment: A One-Year Study in the Southeast of Brazil. Viruses 2025; 17:736. [PMID: 40431747 PMCID: PMC12115472 DOI: 10.3390/v17050736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2025] [Revised: 05/06/2025] [Accepted: 05/10/2025] [Indexed: 05/29/2025] Open
Abstract
Enteric viruses, such as the Aichi virus (AiV), pose a potential health risk due to their high excretion rates through fecal elimination, limited removal during treatment processes, and prolonged survival, highlighting the need to assess the potential for exposure and disease transmission through sanitation systems. This study investigated the prevalence of AiV at three key stages of sewage treatment in the city of São José do Rio Preto, São Paulo state, Brazil, as well as its viral concentrations, infectious potential, and molecular characterization. The data were also analyzed for potential correlations with reported diarrheal disease cases in the city and the physicochemical properties of sewage. The methodology employed included Nested PCR, qPCR, Sanger Sequencing, and phylogenetic analysis, as well as infectivity testing in cell cultures. The prevalence of AiV throughout the year in raw sewage samples was 90.4%, 78.8% in post-anaerobic biological treatment, and 71.1% in post-chemical treatment, totaling 125 positive samples out of 156, being characterized as AiV genotype A. The virus also demonstrated persistence and infectious potential at all three stages analyzed. The AiV-A mean concentration ranged from 2.05 log10 to 4.64 GC/mL, 2.31 to 4.72 log10 GC/mL, and 2.13 to 2.85 log10 GC/mL for the same treatment stages, respectively. A significant difference (p ≤ 0.05) suggests higher viral concentrations in summer at the three sewage process points analyzed, while lower viral concentrations were observed in post-chemical treatment samples (p ≤ 0.01). Additionally, no statistically significant relationship was observed between the virus occurrence in samples and cases of acute diarrheal diseases in the city. In conclusion, this study highlights that much remains to be understood about AiV while providing valuable insights into the relationship between AiV, environmental factors, and public health.
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Affiliation(s)
- Mariah C. A. do Nascimento
- Department of Biology, São Paulo State University (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (M.C.A.d.N.); (C.R.R.); (D.B.G.); (P.R.)
| | - Camila R. Rosa
- Department of Biology, São Paulo State University (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (M.C.A.d.N.); (C.R.R.); (D.B.G.); (P.R.)
| | - Meriane Demoliner
- Molecular Microbiology Laboratory, University Feevale, Novo Hamburgo 93525-075, RS, Brazil; (M.D.); (F.R.S.)
| | - Dayla B. Geraldini
- Department of Biology, São Paulo State University (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (M.C.A.d.N.); (C.R.R.); (D.B.G.); (P.R.)
| | - Guilherme R. F. Campos
- Department of Dermatological, Infectious and Parasitic Diseases, Medical School of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil;
| | - Daniela M. Quevedo
- Institute of Exact and Technological Sciences (ICET), University Feevale, Novo Hamburgo 93525-075, RS, Brazil;
| | - Rafael N. Miceli
- SeMAE—Autonomous Municipal Water and Sewage Service, São José do Rio Preto 15048-000, SP, Brazil;
| | - Fernando R. Spilki
- Molecular Microbiology Laboratory, University Feevale, Novo Hamburgo 93525-075, RS, Brazil; (M.D.); (F.R.S.)
| | - João Pessoa Araújo
- Biotechnology Institute, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil;
| | - Marilia F. Calmon
- Department of Biology, São Paulo State University (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (M.C.A.d.N.); (C.R.R.); (D.B.G.); (P.R.)
| | - Paula Rahal
- Department of Biology, São Paulo State University (UNESP), São José do Rio Preto 15054-000, SP, Brazil; (M.C.A.d.N.); (C.R.R.); (D.B.G.); (P.R.)
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Santos AFB, Nunes M, Filipa-Silva A, Pimentel V, Pingarilho M, Abrantes P, Miranda MNS, Crespo MTB, Abecasis AB, Parreira R, Seabra SG. Wastewater Metavirome Diversity: Exploring Replicate Inconsistencies and Bioinformatic Tool Disparities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:707. [PMID: 40427823 PMCID: PMC12111215 DOI: 10.3390/ijerph22050707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 04/11/2025] [Accepted: 04/16/2025] [Indexed: 05/29/2025]
Abstract
This study investigates viral composition in wastewater through metagenomic analysis, evaluating the performance of four bioinformatic tools-Genome Detective, CZ.ID, INSaFLU-TELEVIR and Trimmomatic + Kraken2-on samples collected from four sites in each of two wastewater treatment plants (WWTPs) in Lisbon, Portugal in April 2019. From each site, we collected and processed separately three replicates and one pool of nucleic acids extracted from the replicates. A total of 32 samples were processed using sequence-independent single-primer amplification (SISPA) and sequenced on an Illumina MiSeq platform. Across the 128 sample-tool combinations, viral read counts varied widely, from 3 to 288,464. There was a lack of consistency between replicates and their pools in terms of viral abundance and diversity, revealing the heterogeneity of the wastewater matrix and the variability in sequencing effort. There was also a difference between software tools highlighting the impact of tool selection on community profiling. A positive correlation between crAssphage and human pathogens was found, supporting crAssphage as a proxy for public health surveillance. A custom Python pipeline automated viral identification report processing, taxonomic assignments and diversity calculations, streamlining analysis and ensuring reproducibility. These findings emphasize the importance of sequencing depth, software tool selection and standardized pipelines in advancing wastewater-based epidemiology.
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Affiliation(s)
- André F. B. Santos
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, 1349-008 Lisboa, Portugal; (A.F.B.S.); (V.P.); (M.P.); (P.A.); (M.N.S.M.); (A.B.A.); (R.P.)
| | - Mónica Nunes
- cE3c—Centre for Ecology, Evolution and Environmental Changes & CHANGE—Global Change and Sustainability Institute, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal;
| | - Andreia Filipa-Silva
- CIIMAR/CIMAR-LA, Centro Interdisciplinar de Investigação Marinha e Ambiental, Universidade do Porto, Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos, s/n, 4450-208 Matosinhos, Portugal;
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, 1349-008 Lisboa, Portugal; (A.F.B.S.); (V.P.); (M.P.); (P.A.); (M.N.S.M.); (A.B.A.); (R.P.)
| | - Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, 1349-008 Lisboa, Portugal; (A.F.B.S.); (V.P.); (M.P.); (P.A.); (M.N.S.M.); (A.B.A.); (R.P.)
| | - Patrícia Abrantes
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, 1349-008 Lisboa, Portugal; (A.F.B.S.); (V.P.); (M.P.); (P.A.); (M.N.S.M.); (A.B.A.); (R.P.)
| | - Mafalda N. S. Miranda
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, 1349-008 Lisboa, Portugal; (A.F.B.S.); (V.P.); (M.P.); (P.A.); (M.N.S.M.); (A.B.A.); (R.P.)
| | - Maria Teresa Barreto Crespo
- iBET, Instituto de Biologia Experimental e Tecnológica, Apartado 12, 2781-901 Oeiras, Portugal;
- ITQB, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, 2780-157 Oeiras, Portugal
| | - Ana B. Abecasis
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, 1349-008 Lisboa, Portugal; (A.F.B.S.); (V.P.); (M.P.); (P.A.); (M.N.S.M.); (A.B.A.); (R.P.)
| | - Ricardo Parreira
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, 1349-008 Lisboa, Portugal; (A.F.B.S.); (V.P.); (M.P.); (P.A.); (M.N.S.M.); (A.B.A.); (R.P.)
| | - Sofia G. Seabra
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa, 1349-008 Lisboa, Portugal; (A.F.B.S.); (V.P.); (M.P.); (P.A.); (M.N.S.M.); (A.B.A.); (R.P.)
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Bhatia S, Maswanganye TN, Jeje O, Winston D, Lamssali M, Deng D, Blakley I, Fodor AA, Jeffers-Francis L. Wastewater Speaks: Evaluating SARS-CoV-2 Surveillance, Sampling Methods, and Seasonal Infection Trends on a University Campus. Microorganisms 2025; 13:924. [PMID: 40284761 PMCID: PMC12029416 DOI: 10.3390/microorganisms13040924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Revised: 03/27/2025] [Accepted: 04/03/2025] [Indexed: 04/29/2025] Open
Abstract
Wastewater surveillance has emerged as a cost-effective and equitable approach for tracking the spread of SARS-CoV-2. In this study, we monitored the prevalence of SARS-CoV-2 on a university campus over three years (2021-2023) using wastewater-based epidemiology (WBE). Wastewater samples were collected from 11 manholes on campus, each draining wastewater from a corresponding dormitory building, and viral RNA concentrations were measured using reverse transcription-quantitative PCR (RT-qPCR). Weekly clinical case data were also obtained from the university health center. A strong positive and significant correlation was observed between Grab and Composite sampling methods, supporting their robustness as equally effective approaches for sample collection. Specifically, a strong correlation was observed between Aggie Village 4 Grab and Aggie Village 4 Composite samples (R2 = 0.84, p = 0.00) and between Barbee Grab and Barbee Composite samples (R2 = 0.80, p = 0.00). Additionally, higher viral RNA copies of SARS-CoV-2 (N1 gene) were detected during the Spring semester compared to the Fall and Summer semesters. Notably, elevations in raw N1 concentrations were observed shortly after the return of college students to campus, suggesting that these increases were predominantly associated with students returning at the beginning of the Fall and Spring semesters (January and August). To account for variations in fecal loading, SARS-CoV-2 RNA concentrations were normalized using Pepper Mild Mottle Virus (PMMoV), a widely used viral fecal biomarker. However, normalization using PMMoV did not improve correlations between SARS-CoV-2 RNA levels and clinical case data. Despite these findings, our study did not establish WBE as a consistently reliable complement to clinical testing in a university campus setting, contrary to many retrospective studies. One key limitation was that numerous off-campus students did not contribute to the campus wastewater system corresponding to the monitored dormitories. However, some off-campus students were still subjected to clinical testing at the university health center under mandated protocols. Moreover, the university health center discontinued reporting cases per dormitory after 2021, making direct comparisons more challenging. Nevertheless, this study highlights the continued value of WBE as a surveillance tool for monitoring infectious diseases and provides critical insights into its application in campus environments.
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Affiliation(s)
- Shilpi Bhatia
- Biology Department, College of Science and Technology, North Carolina A&T State University, 1601 E. Market Street, Greensboro, NC 27411, USA; (S.B.); (O.J.); (D.W.)
| | - Tinyiko Nicole Maswanganye
- Biology Department, College of Science and Technology, North Carolina A&T State University, 1601 E. Market Street, Greensboro, NC 27411, USA; (S.B.); (O.J.); (D.W.)
| | - Olusola Jeje
- Biology Department, College of Science and Technology, North Carolina A&T State University, 1601 E. Market Street, Greensboro, NC 27411, USA; (S.B.); (O.J.); (D.W.)
| | - Danielle Winston
- Biology Department, College of Science and Technology, North Carolina A&T State University, 1601 E. Market Street, Greensboro, NC 27411, USA; (S.B.); (O.J.); (D.W.)
| | - Mehdi Lamssali
- Built Environment Department, College of Science and Technology, North Carolina A&T State University, 1601 E. Market Street, Greensboro, NC 27411, USA; (M.L.); (D.D.)
| | - Dongyang Deng
- Built Environment Department, College of Science and Technology, North Carolina A&T State University, 1601 E. Market Street, Greensboro, NC 27411, USA; (M.L.); (D.D.)
| | - Ivory Blakley
- College of Computing and Informatics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA (A.A.F.)
| | - Anthony A. Fodor
- College of Computing and Informatics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA (A.A.F.)
| | - Liesl Jeffers-Francis
- Biology Department, College of Science and Technology, North Carolina A&T State University, 1601 E. Market Street, Greensboro, NC 27411, USA; (S.B.); (O.J.); (D.W.)
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Garcia I, Riis RK, Moen LV, Rohringer A, Madslien EH, Bragstad K. Unsupervised detection of novel SARS-CoV-2 mutations and lineages in wastewater samples using long-read sequencing. BMC Genomics 2025; 26:87. [PMID: 39881253 PMCID: PMC11780762 DOI: 10.1186/s12864-025-11255-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 01/17/2025] [Indexed: 01/31/2025] Open
Abstract
The COVID-19 pandemic has underscored the importance of virus surveillance in public health and wastewater-based epidemiology (WBE) has emerged as a non-invasive, cost-effective method for monitoring SARS-CoV-2 and its variants at the community level. Unfortunately, current variant surveillance methods depend heavily on updated genomic databases with data derived from clinical samples, which can become less sensitive and representative as clinical testing and sequencing efforts decline.In this paper, we introduce HERCULES (High-throughput Epidemiological Reconstruction and Clustering for Uncovering Lineages from Environmental SARS-CoV-2), an unsupervised method that uses long-read sequencing of a single 1 Kb fragment of the Spike gene. HERCULES identifies and quantifies mutations and lineages without requiring database-guided deconvolution, enhancing the detection of novel variants.We evaluated HERCULES on Norwegian wastewater samples collected from July 2022 to October 2023 as part of a national pilot on WBE of SARS-CoV-2. Strong correlations were observed between wastewater and clinical sample data in terms of prevalence of mutations and lineages. Furthermore, we found that SARS-CoV-2 trends in wastewater samples were identified one week earlier than in clinical data.Our results demonstrate HERCULES' capability to identify new lineages before their detection in clinical samples, providing early warnings of potential outbreaks. The methodology described in this paper is easily adaptable to other pathogens, offering a versatile tool for environmental surveillance of new emerging pathogens.
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Affiliation(s)
- Ignacio Garcia
- Department of Bacteriology, Norwegian Institute of Public Health, Oslo, 0456, Norway.
| | - Rasmus K Riis
- Department of Virology, Norwegian Institute of Public Health, Oslo, 0456, Norway
| | - Line V Moen
- Department of Virology, Norwegian Institute of Public Health, Oslo, 0456, Norway
| | - Andreas Rohringer
- Department of Virology, Norwegian Institute of Public Health, Oslo, 0456, Norway
| | - Elisabeth H Madslien
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, 0456, Norway
| | - Karoline Bragstad
- Department of Virology, Norwegian Institute of Public Health, Oslo, 0456, Norway
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Jourdain F, Toro L, Senta-Loÿs Z, Deryene M, Mokni W, Azevedo Da Graça T, Le Strat Y, Rahali S, Yamada A, Maisa A, Pretet M, Sudour J, Cordevant C, Chesnot T, Roman V, Wilhelm A, Gassilloud B, Mouly D. Wastewater-Based Epidemiological Surveillance in France: The SUM'EAU Network. Microorganisms 2025; 13:281. [PMID: 40005648 PMCID: PMC11857653 DOI: 10.3390/microorganisms13020281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 01/16/2025] [Accepted: 01/22/2025] [Indexed: 02/27/2025] Open
Abstract
Wastewater surveillance is a powerful public health tool which gained global prominence during the COVID-19 pandemic. This article describes the development and implementation of the national wastewater surveillance network in France: SUM'EAU. Preliminary work included defining a sampling strategy, evaluating/optimising analytical methods, launching a call for tenders to select network laboratories and producing wastewater monitoring indicators. SUM'EAU was then deployed in three stages: (i) a pilot study, (ii) the transfer of analytical activities from the National Reference Laboratory to four selected network laboratories, and (iii) the extension of the system to additional sampling sites. Currently, SUM'EAU monitors SARS-CoV-2 across 54 wastewater treatment plants in mainland France. Once a week on business days, 24 h flow-proportional composite samples are collected at plant inlets and transported at 5 °C (±3 °C) to partner laboratories for analysis. The analytical process involves sample concentration, RNA extraction, and digital RT-PCR/q-RT-PCR to detect and quantify the presence of the SARS-CoV-2 genome in wastewater. Subsequently, data are transferred to Santé publique France, the French National Public Health Agency, for analysis and interpretation. While SUM'EAU has been instrumental in monitoring the COVID-19 pandemic and holds significant potential for broader application, securing sustainable funding for its operation remains a major challenge.
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Affiliation(s)
- Frédéric Jourdain
- Occitanie Regional Office, Regional Division, Santé Publique France (French National Public Health Agency), 31050 Toulouse, France;
| | - Laila Toro
- Occitanie Regional Office, Regional Division, Santé Publique France (French National Public Health Agency), 31050 Toulouse, France;
| | - Zoé Senta-Loÿs
- General Directorate for Health, Ministry of Health, 75007 Paris, France (W.M.)
| | - Marilyne Deryene
- General Directorate for Health, Ministry of Health, 75007 Paris, France (W.M.)
| | - Walid Mokni
- General Directorate for Health, Ministry of Health, 75007 Paris, France (W.M.)
| | - Tess Azevedo Da Graça
- Data Division, Santé Publique France (French National Public Health Agency), 94415 Saint-Maurice, France
| | - Yann Le Strat
- Data Division, Santé Publique France (French National Public Health Agency), 94415 Saint-Maurice, France
| | - Sofiane Rahali
- Data Division, Santé Publique France (French National Public Health Agency), 94415 Saint-Maurice, France
| | - Ami Yamada
- Regional Division, Santé Publique France (French National Public Health Agency), 94415 Saint-Maurice, France;
| | - Anna Maisa
- Infectious Diseases Division, Santé Publique France (French National Public Health Agency), 94415 Saint-Maurice, France
| | - Maël Pretet
- Data Division, Santé Publique France (French National Public Health Agency), 94415 Saint-Maurice, France
| | - Jeanne Sudour
- Data Division, Santé Publique France (French National Public Health Agency), 94415 Saint-Maurice, France
| | - Christophe Cordevant
- Strategy and Programs Department, Research and Reference Division, ANSES, 94701 Maisons-Alfort, France;
| | - Thierry Chesnot
- Nancy Laboratory for Hydrology, ANSES, 54000 Nancy, France (V.R.)
| | - Veronica Roman
- Nancy Laboratory for Hydrology, ANSES, 54000 Nancy, France (V.R.)
| | - Amandine Wilhelm
- Nancy Laboratory for Hydrology, ANSES, 54000 Nancy, France (V.R.)
| | | | - Damien Mouly
- Occitanie Regional Office, Regional Division, Santé Publique France (French National Public Health Agency), 31050 Toulouse, France;
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Farmer-Diaz K, Matthew-Bernard M, Cheetham S, Mitchell K, Macpherson CNL, Ramos-Nino ME. Optimized Aluminum Hydroxide Adsorption-Precipitation for Improved Viral Detection in Wastewater. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:148. [PMID: 40003374 PMCID: PMC11855335 DOI: 10.3390/ijerph22020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 12/31/2024] [Accepted: 01/21/2025] [Indexed: 02/27/2025]
Abstract
Wastewater-based epidemiology (WBE) is a valuable tool for monitoring pathogen spread in communities; however, current protocols mainly target non-enveloped viruses. This study addresses the need for standardized methods to detect both enveloped and non-enveloped viruses by testing four aluminum hydroxide adsorption-precipitation techniques. Wastewater samples were spiked with an enveloped virus surrogate (Φ6 bacteriophage) and a non-enveloped virus surrogate (MS2 coliphage), and viral recovery was assessed using reverse-transcription quantitative PCR (RT-qPCR). The highest recovery for the enveloped virus was achieved with AlCl3 at pH 3.5, a 15 min flocculation time, and a 3% elution solution concentration. For the non-enveloped virus, optimal recovery was found with AlCl3 at pH 6.0, no flocculation time, and a 10% elution solution. The best method for recovering both virus types used AlCl3 at pH 6.0, 15 min flocculation, and a 3% elution solution concentration. This study shows that while optimal conditions vary between virus types, a standardized AlCl3 flocculation protocol can efficiently recover both, providing a cost-effective approach for outbreak monitoring in Grenada.
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Affiliation(s)
- Karla Farmer-Diaz
- Department of Microbiology, Immunology, and Pharmacology, School of Medicine, St. George’s University, St George P.O Box 7, Grenada; (K.F.-D.); (M.M.-B.)
| | - Makeda Matthew-Bernard
- Department of Microbiology, Immunology, and Pharmacology, School of Medicine, St. George’s University, St George P.O Box 7, Grenada; (K.F.-D.); (M.M.-B.)
| | - Sonia Cheetham
- Department of Pathobiology, School of Veterinary Medicine, St. George’s University, St George P.O Box 7, Grenada;
| | - Kerry Mitchell
- Department of Public Health and Preventive Medicine, School of Medicine, St. George’s University, St George P.O Box 7, Grenada;
| | | | - Maria E. Ramos-Nino
- Department of Microbiology, Immunology, and Pharmacology, School of Medicine, St. George’s University, St George P.O Box 7, Grenada; (K.F.-D.); (M.M.-B.)
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