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Baz Lomba JA, Pires J, Myrmel M, Arnø JK, Madslien EH, Langlete P, Amato E, Hyllestad S. Effectiveness of environmental surveillance of SARS-CoV-2 as an early-warning system: Update of a systematic review during the second year of the pandemic. JOURNAL OF WATER AND HEALTH 2024; 22:197-234. [PMID: 38295081 PMCID: wh_2023_279 DOI: 10.2166/wh.2023.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
The aim of this updated systematic review was to offer an overview of the effectiveness of environmental surveillance (ES) of SARS-CoV-2 as a potential early-warning system (EWS) for COVID-19 and new variants of concerns (VOCs) during the second year of the pandemic. An updated literature search was conducted to evaluate the added value of ES of SARS-CoV-2 for public health decisions. The search for studies published between June 2021 and July 2022 resulted in 1,588 publications, identifying 331 articles for full-text screening. A total of 151 publications met our inclusion criteria for the assessment of the effectiveness of ES as an EWS and early detection of SARS-CoV-2 variants. We identified a further 30 publications among the grey literature. ES confirms its usefulness as an EWS for detecting new waves of SARS-CoV-2 infection with an average lead time of 1-2 weeks for most of the publication. ES could function as an EWS for new VOCs in areas with no registered cases or limited clinical capacity. Challenges in data harmonization and variant detection require standardized approaches and innovations for improved public health decision-making. ES confirms its potential to support public health decision-making and resource allocation in future outbreaks.
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Affiliation(s)
- Jose Antonio Baz Lomba
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway E-mail:
| | - João Pires
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway; ECDC fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Mette Myrmel
- Faculty of Veterinary Medicine, Virology Unit, Norwegian University of Life Science (NMBU), Oslo, Norway
| | - Jorunn Karterud Arnø
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Elisabeth Henie Madslien
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Petter Langlete
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Ettore Amato
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Susanne Hyllestad
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
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Neyra M, Hill DT, Bennett LJ, Dunham CN, Larsen DA. Establishing a Statewide Wastewater Surveillance System in Response to the COVID-19 Pandemic: A Reliable Model for Continuous and Emerging Public Health Threats. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:854-862. [PMID: 37566797 PMCID: PMC10549888 DOI: 10.1097/phh.0000000000001797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
CONTEXT The COVID-19 pandemic sparked efforts across the globe to implement wastewater surveillance for SARS-CoV-2. PROGRAM New York State (NYS) established the NYS Wastewater Surveillance Network to estimate the levels of COVID-19 community risk and to provide an early indication of SARS-CoV-2 transmission trends. The network is designed to provide a better understanding of public health burdens and to assist health departments to respond effectively to public health threats. IMPLEMENTATION Wastewater surveillance across NYS increased from sporadic and geographically spare in 2020 to routine and widespread in 2022, reaching all 62 counties in the state and covering 74% of New Yorkers. The network team focused on engaging local health departments and wastewater treatment plants to provide wastewater samples, which are then analyzed through a network-affiliated laboratory. Both participating local health departments and wastewater treatment plants receive weekly memos on current SARS-CoV-2 trends and levels. The data are also made publicly available at the state dashboard. EVALUATION Using standard indicators to evaluate infectious disease surveillance systems, the NYS Wastewater Surveillance Network was assessed for accuracy, timeliness, and completeness during the first year of operations. We observed 96.5% sensitivity of wastewater to identify substantial/high COVID-19 transmission and 99% specificity to identify low COVID-19 transmission. In total, 80% of results were reported within 1 day of sample collection and were published on the public dashboard within 2 days of sample collection. Among participating wastewater treatment plants, 32.5% provided weekly samples with zero missing data, 31% missed 1 or 2 weeks, and 36.5% missed 3 or more weeks. DISCUSSION The NYS Wastewater Surveillance Network continues to be a key component of the state and local health departments' pandemic response. The network fosters prompt public health actions through real-time data, enhancing the preparedness capability for both existing and emerging public health threats.
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Affiliation(s)
- Milagros Neyra
- Department of Public Health at Syracuse University, Syracuse, New York (Ms Neyra and Drs Hill and Larsen); School of Information Studies at Syracuse University, Syracuse, New York (Mr Dunham); New York State Department of Health, Albany, New York (Ms Bennett); and CDC Foundation, Atlanta, Georgia (Ms Bennett)
| | - Dustin T. Hill
- Department of Public Health at Syracuse University, Syracuse, New York (Ms Neyra and Drs Hill and Larsen); School of Information Studies at Syracuse University, Syracuse, New York (Mr Dunham); New York State Department of Health, Albany, New York (Ms Bennett); and CDC Foundation, Atlanta, Georgia (Ms Bennett)
| | - Lydia J. Bennett
- Department of Public Health at Syracuse University, Syracuse, New York (Ms Neyra and Drs Hill and Larsen); School of Information Studies at Syracuse University, Syracuse, New York (Mr Dunham); New York State Department of Health, Albany, New York (Ms Bennett); and CDC Foundation, Atlanta, Georgia (Ms Bennett)
| | - Christopher N. Dunham
- Department of Public Health at Syracuse University, Syracuse, New York (Ms Neyra and Drs Hill and Larsen); School of Information Studies at Syracuse University, Syracuse, New York (Mr Dunham); New York State Department of Health, Albany, New York (Ms Bennett); and CDC Foundation, Atlanta, Georgia (Ms Bennett)
| | - David A. Larsen
- Department of Public Health at Syracuse University, Syracuse, New York (Ms Neyra and Drs Hill and Larsen); School of Information Studies at Syracuse University, Syracuse, New York (Mr Dunham); New York State Department of Health, Albany, New York (Ms Bennett); and CDC Foundation, Atlanta, Georgia (Ms Bennett)
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Schill R, Nelson KL, Harris-Lovett S, Kantor RS. The dynamic relationship between COVID-19 cases and SARS-CoV-2 wastewater concentrations across time and space: Considerations for model training data sets. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 871:162069. [PMID: 36754324 PMCID: PMC9902279 DOI: 10.1016/j.scitotenv.2023.162069] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
During the COVID-19 pandemic, wastewater-based surveillance has been used alongside diagnostic testing to monitor infection rates. With the decline in cases reported to public health departments due to at-home testing, wastewater data may serve as the primary input for epidemiological models, but training these models is not straightforward. We explored factors affecting noise and bias in the ratio between wastewater and case data collected in 26 sewersheds in California from October 2020 to March 2022. The strength of the relationship between wastewater and case data appeared dependent on sampling frequency and population size, but was not increased by wastewater normalization to flow rate or case count normalization to testing rates. Additionally, the lead and lag times between wastewater and case data varied over time and space, and the ratio of log-transformed individual cases to wastewater concentrations changed over time. This ratio decreased between the Epsilon/Alpha and Delta variant surges of COVID-19 and increased during the Omicron BA.1 variant surge, and was also related to the diagnostic testing rate. Based on this analysis, we present a framework of scenarios describing the dynamics of the case to wastewater ratio to aid in data handling decisions for ongoing modeling efforts.
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Affiliation(s)
- Rebecca Schill
- TUM School of Engineering and Design, Technical University of Munich, Germany
| | - Kara L Nelson
- Civil and Environmental Engineering, University of California, Berkeley, CA, USA
| | | | - Rose S Kantor
- Civil and Environmental Engineering, University of California, Berkeley, CA, USA.
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Hill DT, Larsen DA. Using geographic information systems to link population estimates to wastewater surveillance data in New York State, USA. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001062. [PMID: 36962986 PMCID: PMC10021809 DOI: 10.1371/journal.pgph.0001062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/08/2022] [Indexed: 01/27/2023]
Abstract
Sewer systems provide many services to communities that have access to them beyond removal of waste and wastewater. Understanding of these systems' geographic coverage is essential for wastewater-based epidemiology (WBE), which requires accurate estimates for the population contributing wastewater. Reliable estimates for the boundaries of a sewer service area or sewershed can be used to link upstream populations to wastewater samples taken at treatment plants or other locations within a sewer system. These geographic data are usually managed by public utilities, municipal offices, and some government agencies, however, there are no centralized databases for geographic information on sewer systems in New York State. We created a database for all municipal sewersheds in New York State for the purpose of supporting statewide wastewater surveillance efforts to support public health. We used a combination of public tax records with sewer access information, physical maps, and municipal records to organize and draw digital boundaries compatible with geographic information systems. The methods we employed to create these data will be useful to inform similar efforts in other jurisdictions and the data have many public health applications as well as being informative for water/environmental research and infrastructure projects.
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Affiliation(s)
- Dustin T Hill
- Department of Public Health, Syracuse University, Syracuse, New York, United States of America
| | - David A Larsen
- Department of Public Health, Syracuse University, Syracuse, New York, United States of America
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LaJoie AS, Holm RH, Anderson LB, Ness HD, Smith T. Nationwide public perceptions regarding the acceptance of using wastewater for community health monitoring in the United States. PLoS One 2022; 17:e0275075. [PMID: 36219594 PMCID: PMC9553059 DOI: 10.1371/journal.pone.0275075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/09/2022] [Indexed: 11/07/2022] Open
Abstract
To assess the levels of infection across communities during the coronavirus disease 2019 pandemic, researchers have measured severe acute respiratory syndrome coronavirus 2 RNA in feces dissolved in sewer water. This activity is colloquially known as sewer monitoring and is referred to as wastewater-based epidemiology in academic settings. Although global ethical principles have been described, sewer monitoring is unregulated for health privacy protection when used for public health surveillance in the United States. This study used Qualtrics XM, a national research panel provider, to recruit participants to answer an online survey. Respondents (N = 3,083) answered questions about their knowledge, perceptions of what is to be monitored, where monitoring should occur, and privacy concerns related to sewer monitoring as a public health surveillance tool. Furthermore, a privacy attitude questionnaire was used to assess the general privacy boundaries of respondents. Participants were more likely to support monitoring for diseases (92%), environmental toxins (92%), and terrorist threats (88%; e.g., anthrax). Two-third of the respondents endorsed no prohibition on location sampling scale (e.g., monitoring single residence to entire community was acceptable); the most common location category respondents wanted to prohibit sampling was at personal residences. Sewer monitoring is an emerging technology, and our study sheds light on perceptions that could benefit from educational programs in areas where public acceptance is comparatively lower. Respondents clearly communicated guard rails for sewer monitoring, and public opinion should inform future policy, application, and regulation measures.
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Affiliation(s)
- A. Scott LaJoie
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Rochelle H. Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
- * E-mail:
| | - Lauren B. Anderson
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Heather D. Ness
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
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LaJoie AS, Holm RH, Anderson LB, Ness HD, Smith T. Nationwide public perceptions regarding the acceptance of using wastewater for community health monitoring in the United States. PLoS One 2022. [PMID: 36219594 DOI: 10.1101/2022.03.16.22272262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
To assess the levels of infection across communities during the coronavirus disease 2019 pandemic, researchers have measured severe acute respiratory syndrome coronavirus 2 RNA in feces dissolved in sewer water. This activity is colloquially known as sewer monitoring and is referred to as wastewater-based epidemiology in academic settings. Although global ethical principles have been described, sewer monitoring is unregulated for health privacy protection when used for public health surveillance in the United States. This study used Qualtrics XM, a national research panel provider, to recruit participants to answer an online survey. Respondents (N = 3,083) answered questions about their knowledge, perceptions of what is to be monitored, where monitoring should occur, and privacy concerns related to sewer monitoring as a public health surveillance tool. Furthermore, a privacy attitude questionnaire was used to assess the general privacy boundaries of respondents. Participants were more likely to support monitoring for diseases (92%), environmental toxins (92%), and terrorist threats (88%; e.g., anthrax). Two-third of the respondents endorsed no prohibition on location sampling scale (e.g., monitoring single residence to entire community was acceptable); the most common location category respondents wanted to prohibit sampling was at personal residences. Sewer monitoring is an emerging technology, and our study sheds light on perceptions that could benefit from educational programs in areas where public acceptance is comparatively lower. Respondents clearly communicated guard rails for sewer monitoring, and public opinion should inform future policy, application, and regulation measures.
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Affiliation(s)
- A Scott LaJoie
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Rochelle H Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Lauren B Anderson
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Heather D Ness
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
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