Harnessing the Power of the Census: Characterizing Wastewater Treatment Plant Catchment Populations for Wastewater-Based Epidemiology

Refining the correction factor for a better monitoring of antidepressant use by wastewater-based epidemiology: A case study of amitriptyline

Wastewater-based epidemiology (WBE) is proposed as a cost-effective approach to objectively monitor the antidepressant use but it requires more accurate correction factors (CF) than what had been used in previous studies. Amitriptyline is a popular prescription medicine for treating depression and nerve pain, which could be prone to misuse and need monitoring. The CF of amitriptyline employed in previous WBE studies varied from 10 to 100, leading to substantial disparities between WBE estimates and expected mass of antidepressants in wastewater. Hence, this study aimed to take amitriptyline as a case study and refine the CF by correlating mass loads measured in wastewater from 12.2 million inhabitants collected during the 2016 Census with corresponding annual sales data. The triangulation of WBE data and sales data resulted in a newly-derived CF of 7, which is significantly different from the CF values used in previous studies. The newly derived CF was applied to a secondary, multi-year (2017 to 2020) WBE dataset for validation against sales data in the same period, demonstrating the estimated amitriptyline use (380 ± 320 mg/day/1000 inhabitants) is consistent with sales data (450 ± 190 mg/day/1000 inhabitants). When we applied the new CF to previous studies, the wastewater consumption loads matched better to prescription data than previous WBE estimations. The refined CF of amitriptyline can be used in future WBE studies to improve the accuracy of the consumption estimates.

Testing methods to estimate population size for wastewater treatment plants using census data: Implications for wastewater-based epidemiology

In wastewater-based epidemiology (WBE), wastewater loads are commonly reported as a per capita value. Census population counts are often used to obtain a population size to normalise wastewater loads. However, the methods used to calculate the population size of wastewater treatment plants (WWTPs) from census data are rarely reported in the WBE literature. This is problematic because the geographical extents of wastewater catchments and census area units rarely align perfectly with each other and exist at different spatial scales. This complicates efforts to estimate the number of people serviced by WWTPs in these census area units. This study compared four geospatial methods to combine wastewater catchment areas and census area units to calculate the census population size of wastewater treatment plants. These methods were applied nationally to WWTPs across New Zealand. Population estimates varied by up to 73 % between the methods, which could skew comparisons of per capita wastewater loads between sites. Variability in population estimates (relative standard deviation, RSD) was significantly higher in smaller catchments (rs = -0.727, P < .001), highlighting the importance of method selection in smaller sites. Census population estimates were broadly similar to those provided by wastewater operators, but significant variation was observed for some sites (ranging from 42 % lower to 78 % higher, RSD = 262 %). We present a widely applicable method to calculate population size from census, which involves disaggregating census area units by individual properties. The results reinforce the need for transparent reporting to maintain confidence in the comparison of WBE across sites and studies.

Spatial and temporal trends of 64 pesticides and their removal from Australian wastewater

Pesticides are necessary for the control of pest plant, fungi and insect species. After application, they may find their way into waste streams, such as municipal sewage, where their spatio-temporal distribution has not been well characterised. To further understand the spatio-temporal distribution and to evaluate potential sources and fate after treatment, 64 pesticides were analysed in matched influents and effluents of 22 wastewater treatment plants (WWTPs) from across Australia. The pesticides consisted of 30 herbicides and 8 herbicide metabolites or transformation products, 16 insecticides and 10 fungicides. The samples were 1084 24-hr composite samples pooled into 113 samples. Pools represented two influent and one effluent pools at each of 22 sites in 2019, as well as two pools per year from 2009 to 2021 for an 11-year long-term temporal trend at a subset of two locations. The total population served by the 22 sites was equivalent to ~41 % of the Australian population. Of the 64 pesticides, 25 were detected in influent, with highest influent concentrations up to 100 μg/L and effluent concentrations up to 16 μg/L for the herbicide 2,4-D. The total mass of pesticides was extrapolated to Australia, suggesting ~33 t of the targeted pesticides entered WWTP influent annually nation-wide, with 14 t emitted into effluents annually. Long-term trends varied by analyte and for carbendazim decreases over time, may be related to restrictions in use. Risk quotients (RQs) were calculated for 14 analytes in the effluent. 35 % had an RQ above one, indicating a potential environmental risk. Fipronil had the highest RQ (49) at Site 6. The population-normalized mass loads of pesticides were site-specific, and in some cases correlated with land use attributes suggestive of point sources. This reflects a need to better characterise sources to enable prevention, or possible pre-treatment of pesticide-containing wastewater entering municipal sewage streams.

Exploring drug consumption patterns across varying levels of remoteness in Australia

Wastewater-based epidemiology (WBE) relies on representative sampling that is typically achieved with autosamplers that collect time, flow, or volume proportional samples. The expense, resources and operational know-how associated with autosampler operation means they are only typically available at major wastewater treatment plants (WWTPs). This results in a lack of data on consumption levels in regional and remote areas, or in countries that lack the financial means. The aim of this study was to estimate and investigate trends in drug consumption across varying levels of remoteness in Australia. Field-calibrated, microporous polyethylene passive samplers were deployed over 2 periods (Aug/Sept 2019 and 2020) at 43 treatment plants covering all five categories of remoteness, as per Australian Bureau of Statistics definitions (Major cities, Inner regional, Outer regional, Remote, and Very remote). The per capita consumption of cocaine, methylamphetamine, nicotine, oxycodone and MDMA were estimated. No spatial trends between remoteness and drug consumption were observed, except for cocaine, where Major cities had a 5-to-10-fold higher consumption compared to the other levels of remoteness in 2019 and 2020, respectively. Outer regional sites had the highest and lowest methylamphetamine consumption. The variance in drug use among sites was much higher in Remote (and Inner/Outer regional) sites when compared with Major cities. A significant and consistent decrease in oxycodone consumption was observed at all sites between 2019 and 2020, possibly related to regulatory changes and the COVID-19 pandemic where elective surgeries were suspended. The majority of sites experienced a decrease in cocaine and methylamphetamine consumption, possibly due to border restrictions or changes in supply and demand dynamics. This was the first extensive passive sampling study to assess drug consumption in urban, regional, and remote locations, demonstrating that passive samplers can facilitate extension of wastewater-based drug monitoring programs to sites where other representative sampling options are very difficult to implement.

Bisphenols and phthalates in Australian wastewater: A statistical approach for estimating contributions from diffuse and point sources

Chemicals associated with plastics, such as bisphenols and phthalates, enter sewerage from both diffuse (domestic/commercial) and point (industrial) sources. In this study, we aimed to devise a conservative, statistical baseline to estimate contributions from these source types when sampling of specific sources is not possible. Population-normalised mass loads of two bisphenols and nine phthalates were estimated in wastewater samples from 22 sewage treatment plants (STPs) in 2019. Two multiday (10 and 7 day) pools were created for each STP. Baseline (diffuse) release thresholds were set at the mean of the first quartile (Q1) plus 10 times the standard deviation (STDV) of this quartile [Q1 mean + (10 x STDV)], with contributions over this considered to come from point sources. Chemicals with at least one population-normalised mass load more than three times their baseline were classified as point-source dominant and the remaining as diffuse-source dominant. Eleven of the twelve chemicals examined were detected above limits of quantification in all wastewater samples. Bisphenol A (BPA), bisphenol S (BPS), di-isononyl phthalate (DiNP) and di-methyl phthalate (DMP) were classified as point-source dominant chemicals. The total annual mass loads entering STPs across Australia were estimated to be 4.2 tonnes/year from diffuse sources and 4.5 tonnes/year from point sources for bisphenols, and 47 tonnes/year from diffuse sources and 5.9 tonnes/year from point sources for phthalates.

Do the lockdown-imposed changes in a wastewater treatment plant catchment's socio-demographics impact longitudinal temporal trends in psychoactive pharmaceutical use?

Wastewater-based epidemiology (WBE) includes the analysis of human metabolic biomarkers of xenobiotics in influent wastewater. WBE complements existing drug utilization approaches and provides objective, spatio-temporal information on the consumption of pharmaceuticals in the general population. This approach was applied to 24-h composite influent wastewater samples from Leuven, Belgium. Daily samples were analysed from September 2019 to December 2019 (n = 76), and on three days of the week (Monday, Wednesday, Saturday) from January 2020 to April 2022 (n = 367). Sample analysis consisted of 96-well solid-phase extraction and liquid chromatography coupled to tandem mass spectrometry. Measured concentrations of 21 biomarkers for antidepressant and opioid use were converted to population-normalized mass loads (PNML) by considering the flow rate and catchment population. To capture population movements, mobile phone data was used. Amitriptyline, hydroxy-bupropion, norcitalopram, citalopram, normirtazapine, trazodone, O-desmethylvenlafaxine, codeine, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), methadone, morphine, O-desmethyltramadol, and tramadol were included in the temporal assessment since concentrations were above the lower limit of quantification. The PNML of most biomarkers increased (with 3-119 %) throughout the sampling period. The population disruption during the COVID-19 pandemic led to a major change in the socio-demographics of the catchment area, resulting in temporal differences in the PNML of the different biomarkers. As such, higher PNML were observed during the different lockdown phases, which were characterized by the outflow of university students and a decreasing commuting in and out the catchment area. The effects of the fluctuating socio-demographics of the catchment population were further evidenced by the different week-weekend pattern of PNMLs over the course of the sampling campaign. Mean parent/metabolite ratios (i.e., citalopram/norcitalopram, tramadol/O-desmethyltramadol, venlafaxine/O-desmethylvenlafaxine, and methadone/EDDP) remained relatively stable throughout the entire sampling campaign (RSD% below 25 % for all ratios, except for methadone/EDDP) and therefore were not affected by this population change.

Understanding common population markers for SARS-CoV-2 RNA normalization in wastewater - A review

Wastewater monitoring and epidemiology have seen renewed interest during the recent COVID-19 pandemic. As a result, there is an increasing need to normalize wastewater-derived viral loads in local populations. Chemical tracers, both exogenous and endogenous compounds, have proven to be more stable and reliable for normalization than biological indicators. However, differing instrumentation and extraction methods can make it difficult to compare results. This review examines current extraction and quantification methods for ten common population indicators: creatinine, coprostanol, nicotine, cotinine, sucralose, acesulfame, androstenedione 5-hydroindoleacetic acid (5-HIAA), caffeine, and 1,7-dimethyluric acid. Some wastewater parameters such as ammonia, total nitrogen, total phosphorus, and daily flowrate were also evaluated. The analytical methods included direct injection, dilute and shoot, liquid/liquid, and solid phase extraction (SPE). Creatine, acesulfame, nicotine, 5-HIAA and androstenedione have been analysed by direct injection into LC-MS; however, most authors prefer to include SPE steps to avoid matrix effects. Both LC-MS and GC-MS have been successfully used to quantify coprostanol in wastewater, and the other selected indicators have been quantified successfully with LC-MS. Acidification to stabilize the sample before freezing to maintain the integrity of samples has been reported to be beneficial. However, there are arguments both for and against working at acidic pHs. Wastewater parameters mentioned earlier are quick and easy to quantify, but the data does not always represent the human population effectively. A preference for population indicators originating solely from humans is apparent. This review summarises methods employed for chemical indicators in wastewater, provides a basis for choosing an appropriate extraction and analysis method, and highlights the utility of accurate chemical tracer data for wastewater-based epidemiology.

Wastewater-based monitoring reveals geospatial-temporal trends for antibiotic-resistant pathogens in a large urban community

Antimicrobial resistance (AMR) is one of the top ten global health threats, and current surveillance programs rarely monitor it outside healthcare settings. This limits our ability to understand and manage the spread of AMR. Wastewater testing has the potential to simply, reliably and continuously survey trends in AMR outside the healthcare settings, as it captures biological material from the entire community. To establish and evaluate such a surveillance, we monitored wastewater for four clinically significant pathogens across the urban area of Greater Sydney, Australia. Untreated wastewater from 25 wastewater treatment plants (WWTPs) covering distinct catchment regions of 5.2 million residents was sampled between 2017 and 2019. Isolates for extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL-E) were consistently detected, suggesting its endemicity in the community. Isolates for carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) were only occasionally detected. The flow normalized relative (FNR) ESBL-E load was positively correlated with the proportion of the population between 19 and 50 years of age, completion of vocational education and the average length of hospital stay. Collectively, these variables explained only a third of the variance of the FNR ESBL-E load, indicating further, yet-unidentified factors as a contributor to the distribution. About half of the variation in the FNR CRE load was explained by the average length of hospital stay, showing healthcare-related drivers. Interestingly, variation in the FNR VRE load was not correlated to healthcare-related parameters but to the number of schools per 10,000 population. Our study provides insight into how routine wastewater surveillance can be used to understand the factors driving the distribution of AMR in an urban community. Such information can help to manage and mitigate the emergence and spread of AMR in important human pathogens.

Application of the metal ions as potential population biomarkers for wastewater-based epidemiology: estimating tobacco consumption in Southern China

Wastewater-based epidemiology (WBE) is an objective approach for the estimation of population-level exposure to a wide range of substances, in which the use of a population biomarker (PB) could significantly reduce back-calculation errors. Although some endogenous or exogenous compounds such as cotinine and other hormones have been developed as PBs, more PBs still need to be identified and evaluated. This study aimed to propose a novel method to estimate population parameters from the mass load of metal ion biomarkers in wastewater, and estimate the consumption of tobacco in 24 cities in Southern China using the developed method. Daily wastewater samples were collected from 234 wastewater treatment plants (WWTPs) in 24 cities in Southern China. Atomic absorption spectroscopy (AAS) was applied to determine the concentrations of common health-related metal ions in wastewater, including sodium (Na), potassium (K), magnesium (Mg), calcium (Ca), iron (Fe), and zinc (Zn), and compared them with the daily mass load of cotinine corresponding to catchment populations. The concentrations of cotinine in wastewater samples were measured using liquid chromatography-tandem mass spectrometry. There were clear and strong correlations between the target metal ion equivalent population and census data. The correlation coefficients (R) were R_K = 0.78, R_Na = 0.66, R_Ca = 0.81, R_Mg = 0.77, and R_Fe = 0.69, at p < 0.01 and R² > 0.6. Subsequently, the combination of WBE and metal ion PBs was used to estimate tobacco consumption. Daily consumption of nicotine was estimated to be approximately 1.76 ± 1.19 mg/d/capita, equivalent to an average of 13.0 ± 8.75 cigarettes/d being consumed by smokers. The data on tobacco consumption in this study were consistent with those in traditional surveys in Southern China. The metal ion potassium is an appropriate PB for reflecting the real-time population and could be used to evaluate the tobacco consumption in WBE study.

Trends and challenges in analytical chemistry for multi-analysis of illicit drugs employing wastewater-based epidemiology

Wastewater-based epidemiology (WBE) for quantification of illicit drug biomarkers (IDBs) in wastewater samples is an effective tool that can provide information about drug consumption. The most commonly quantified IDBs belong to different chemical classes, including cocaine, amphetamine-type stimulants, opioids, and cannabinoids, so the different chemical properties of these molecules pose a challenge in the development of analytical methods for multi-analyte analysis. Recent workflows include the steps of sampling and storage, sample preparation using solid-phase extraction (SPE) or without extraction, and quantification of analytes employing gas or liquid chromatography coupled with mass spectrometry. The greatest difficulty is due to the fact that wastewater samples are complex chemical mixtures containing analytes with different chemical properties, often present at low concentrations. Therefore, in the development of analytical methods, there is the need to simplify and optimize the analytical workflows, reducing associated uncertainties, analysis times, and costs. The present work provides a critical bibliographic survey of studies published from the year 2020 until now, highlighting the challenges and trends of published analytical workflows for the multi-analysis of IDBs in wastewater samples, considering sampling and sample preparation, method validation, and analytical techniques.

A wastewater-based evaluation of the effectiveness of codeine control measures in Australia

BACKGROUND AND AIM

From 1 February 2018, codeine was rescheduled from an over-the-counter (OTC) to a prescription-only medicine in Australia. We used wastewater-based epidemiology to measure changes in population codeine consumption before and after rescheduling.

METHODS

We analysed 3703 wastewater samples from 48 wastewater treatment plants, taken between August 2016 and August 2019. Our samples represented 10.6 million people, 45% of the Australian population in state capitals and regional areas in each state or territory. Codeine concentrations were determined by liquid chromatography-tandem mass spectrometry and converted to per-capita consumption estimates using the site daily wastewater volume, catchment populations and codeine excretion kinetics.

RESULTS

Average per-capita consumption of codeine decreased by 37% nationally immediately after the rescheduling in February 2018 [95% confidence interval (CI) = 35.3-39.4%] and substantially in all states between 24 and 51% (95% CI = 22.4-27.0% and 41.8-59.4%). The decrease was sustained at the lower level to August 2019. Locations with least pharmacy access decreased by 51% (95% CI = 41.7-61.7%), a greater decrease than 37% observed for those with greater pharmacy access (95% CI = 35.1-39.4%). Regional areas decreased by a smaller margin to cities (32 versus 38%, 95% CI = 30.2-34.1% versus 34.9-40.4%, respectively) from a base per-capita usage approximately 40% higher than cities.

CONCLUSION

Wastewater analysis shows that codeine consumption in Australia decreased by approximately 37% following its rescheduling as a prescription-only medicine in 2018. Wastewater-based epidemiology can be used to evaluate changes in population pharmaceutical consumption in responses to changes in drug scheduling.

Spatiotemporal trends and impact of Covid-19 lockdown on eight sewage contaminants in Brisbane, Australia, from 2012 to 2020

This study aims to investigate the spatiotemporal trends and impact of COVID-19 lockdowns to the profile of physiochemical parameters in the influent of wastewater treatment plants (WWTPs) around Brisbane, Australia. One 24-hr composite influent sample was collected from 10 WWTPs and analyzed for a range of physiochemical parameters per week (i.e., chemical oxygen demand (COD), total organic carbon (TOC), total nitrogen (TN), total phosphorus (TP), ammonia, volatile suspended solid (VSS)) and per month (i.e., Ni and Cr) from 2012 to 2020, including the period of COVID-19 lockdowns in the region. The catchments studied were urban, with a mix of domestic and industrial activities contributing towards the contaminant profile. Statistical analysis identified that industrial and commercial land use, as well as population size had a large impact to the parameter loads and profile. Per capita mass loads of Cr in one catchment were 100 times higher than in others from one industrial point source. TP demonstrated a potential monotonic decrease over time due to practical reduction policies that have been implemented for phosphorous content in household detergents, except for one catchment where trade waste from food manufacturing industries contributed to an overall increase of 6.9%/year TP. The COVID-19 lockdown (March-April 2020) posed different impact on different catchments, either decrease (7-61%) or increase (2-40%) of most parameter loads (e.g., COD, TOC, TN, TP, VSS, Ammonia), which was likely driven by catchment characteristics (i.e., the proportion of residential, commercial, and industrial land uses). This study enhances our understanding of spatiotemporal trend of contaminants in the catchments for further effective source control.

National Wastewater Reconnaissance of Analgesic Consumption in Australia

A wastewater-based epidemiology (WBE) method is presented to estimate analgesic consumption and assess the burden of treated pain in Australian communities. Wastewater influent samples from 60 communities, representing ∼52% of Australia's population, were analyzed to quantify the concentration of analgesics used to treat pain and converted to estimates of the amount of drug consumed per day per 1000 inhabitants using pharmacokinetics and WBE data. Consumption was standardized to the defined daily dose per day per 1000 people. The population burden of pain treatment was classified as mild to moderate pain (for non-opioid analgesics) and strong to severe pain (for opioid analgesics). The mean per capita weighted total DDD of non-opioid analgesics was 0.029 DDD/day/person, and that of opioid-based analgesics was 0.037 DDD/day/person across Australia. A greater burden of pain (mild to moderate or strong to severe pain index) was observed at regional and remote sites. The correlation analysis of pain indices with different socioeconomic descriptors revealed that pain affects populations from high to low socioeconomic groups. Australians spent an estimated US $3.5 (AU $5) per day on analgesics. Our findings suggest that WBE could be an effective surveillance tool for estimating the consumption of analgesics at a population scale and assessing the total treated pain burden in communities.

Evaluation of population estimation methods for wastewater-based epidemiology in a metropolitan city

This study evaluated the effect of population estimation on the calculation of drug biomarker consumption using wastewater-based epidemiology. Population estimates using mobile phone data, census data, and wastewater quality parameters, such as biological oxygen demand (BOD), total nitrogen (TN), and total phosphorus (TP), were evaluated in six different wastewater treatment plant catchment areas of Busan Metropolitan City, South Korea. The population based on mobile phone data was affected by the patterns of non-resident population movements in each area. The population-normalized daily loads (PNDLs) of methamphetamine were compared according to the different population results. The PNDLs using the population based on mobile phone data (PNDL_Mobile) was 5.87-27.0 mg/d/1000 people. The PNDL_Mobile values were notably different from the PNDLs using wastewater quality parameters (PNDL_Wastewater) (PNDL_Wastewater/PNDL_Mobile: 51-148 %, mean 93 %, relative standard deviation (RSD) 36 %), indicating the unsuitability of population estimation using BOD, TN, and TP. In areas with a large concentration of workplaces, the PNDLs using census data (PNDL_Census) differed from the PNDL_Mobile values (PNDL_Census/PNDL_Mobile: 57-124 %, mean 94 %, RSD 27 %), whereas other areas showed similar values for PNDL_Census and PNDL_Mobile (PNDL_Census/PNDL_Mobile: 95-108 %, mean 102 %, RSD 4.2 %). In particular, the total population estimates of the six survey areas using census data were approximately the same as those based on mobile phone data (RSD: 0.8 %), indicating a decrease in the influence of the non-residential active population in the entire metropolitan city.

Using geographic information systems to link population estimates to wastewater surveillance data in New York State, USA

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.

Surveillance of SARS-CoV-2 in nine neighborhood sewersheds in Detroit Tri-County area, United States: Assessing per capita SARS-CoV-2 estimations and COVID-19 incidence

Wastewater-based epidemiology (WBE) has been suggested as a useful tool to predict the emergence and investigate the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, we screened appropriate population biomarkers for wastewater SARS-CoV-2 normalization and compared the normalized SARS-CoV-2 values across locations with different demographic characteristics in southeastern Michigan. Wastewater samples were collected between December 2020 and October 2021 from nine neighborhood sewersheds in the Detroit Tri-County area. Using reverse transcriptase droplet digital polymerase chain reaction (RT-ddPCR), concentrations of N1 and N2 genes in the studied sites were quantified, with N1 values ranging from 1.92 × 10² genomic copies/L to 6.87 × 10³ gc/L and N2 values ranging from 1.91 × 10² gc/L to 6.45 × 10³ gc/L. The strongest correlations were observed with between cumulative COVID-19 cases per capita (referred as COVID-19 incidences thereafter), and SARS-CoV-2 concentrations normalized by total Kjeldahl nitrogen (TKN), creatinine, 5-hydroxyindoleacetic acid (5-HIAA) and xanthine when correlating the per capita SARS-CoV-2 and COVID-19 incidences. When SARS-CoV-2 concentrations in wastewater were normalized and compared with COVID-19 incidences, the differences between neighborhoods of varying demographics were reduced as compared to differences observed when comparing non-normalized SARS-CoV-2 with COVID-19 cases. This indicates when studying the disease burden in communities of different demographics, accurate per capita estimation is of great importance. The study suggests that monitoring selected water quality parameters or biomarkers, along with RNA concentrations in wastewater, will allow adequate data normalization for spatial comparisons, especially in areas where detailed sanitary sewage flows and contributing populations in the catchment areas are not available. This opens the possibility of using WBE to assess community infections in rural areas or the developing world where the contributing population of a sample could be unknown.

Wastewater-Based Epidemiology for SARS-CoV-2 Biomarkers: Evaluation of Normalization Methods in Small and Large Communities in Southern Germany

In the context of the COVID-19 pandemic, wastewater-based epidemiology (WBE) emerged as a useful tool to account for the prevalence of SARS-CoV-2 infections on a population scale. In this study, we analyzed wastewater samples from three large (>300,000 people served) and four small (<25,000 people served) communities throughout southern Germany from August to December 2021, capturing the fourth infection wave in Germany dominated by the Delta variant (B.1.617.2). As dilution can skew the SARS-CoV-2 biomarker concentrations in wastewater, normalization to wastewater parameters can improve the relationship between SARS-CoV-2 biomarker data and clinical prevalence data. In this study, we investigated the suitability and performance of various normalization parameters. Influent flow data showed strong relationships to precipitation data; accordingly, flow-normalization reacted distinctly to precipitation events. Normalization by surrogate viruses CrAssphage and pepper mild mottle virus showed varying performance for different sampling sites. The best normalization performance was achieved with a mixed fecal indicator calculated from both surrogate viruses. Analyzing the temporal and spatial variation of normalization parameters proved to be useful to explain normalization performance. Overall, our findings indicate that the performance of surrogate viruses, flow, and hydro-chemical data is site-specific. We recommend testing the suitability of normalization parameters individually for specific sewage systems.

Young population consume twice as much artificial sweetener than the general population - A wastewater-based assessment in China

Understanding artificial sweetener consumption patterns and levels in different demographics is important for formulating public health policies on controlling sugar consumption. There is a considerable knowledge gap with respect to the pattern of artificial sweetener consumption in China. To narrow this gap, wastewater analysis was used to assess the temporal patterns of consumption of seven artificial sweeteners in an urban population and a university town in a megacity in South China over a one-year period. Daily influent wastewater samples were collected from an urban catchment and weekly samples collected from a university sub-catchment. Population normalized per capita consumption of the four detected artificial sweeteners (cyclamate, acesulfame, sucralose and saccharin) in the university catchment (1.0-5.9 mg d^-1 p^-1) was much higher than those in urban catchment (0.5-1.3 mg d^-1 p^-1), indicating younger population consume more artificial sweeteners than the general population. The daily consumption of artificial sweeteners was found to be stable throughout the week in the urban catchment. Time-series analysis showed that an average increase in temperature of 1 °C was associated with an increase consumption of 33 μg d^-1 p^-1 for acesulfame, 15 μg d^-1 p^-1 for sucralose and 14 μg d^-1 p^-1 for saccharin. This was the first study that objectively quantified the greater consumption of artificial sweeteners (proxy for consumption of artificially sweetened food and beverages) in a younger age group when compared to the general population, which could potentially pose a risk of health related diseases.

Wastewater-based epidemiology (WBE) for SARS-CoV-2 - A review focussing on the significance of the sewer network using a Dublin city catchment case study

Wastewater-based epidemiology (WBE) has been employed by many countries globally since the beginning of the COVID-19 pandemic in order to assess the benefits of this surveillance tool in the context of informing public health measures. WBE has been successfully employed to detect SARS-CoV-2 at wastewater treatment plants for community-wide surveillance, as well as in smaller catchments and institutions for targeted surveillance of COVID-19. In addition, WBE has been successfully used to detect new variants, identify areas of high infection levels, as well as to detect new infection outbreaks. However, due to to the large number of inherent uncertainties in the WBE process, including the inherent intricacies of the sewer network, decay of the virus en route to a monitoring point, levels of recovery from sampling and quantification methods, levels of faecal shedding among the infected population, as well as population normalisation methods, the usefulness of wastewater samples as a means of accurately quantifying SARS-CoV-2 infection levels among a population remains less clear. The current WBE programmes in place globally will help to identify new areas of research aimed at reducing the levels of uncertainty in the WBE process, thus improving WBE as a public health monitoring tool for future pandemics. In the meantime, such programmes can provide valuable comparisons to clinical testing data and other public health metrics, as well being an effective early warning tool for new variants and new infection outbreaks. This review includes a case study of sampled wastewater from the sewer network in Dublin, Ireland, during a peak infection period of COVID-19 in the city, which evaluates the different uncertainties in the WBE process.

Socioeconomic status and public health in Australia: A wastewater-based study

Analysis of untreated municipal wastewater is recognized as an innovative approach to assess population exposure to or consumption of various substances. Currently, there are no published wastewater-based studies investigating the relationships between catchment social, demographic, and economic characteristics with chemicals using advanced non-targeted techniques. In this study, fifteen wastewater samples covering 27% of the Australian population were collected during a population Census. The samples were analysed with a workflow employing liquid chromatography high-resolution mass spectrometry and chemometric tools for non-target analysis. Socioeconomic characteristics of catchment areas were generated using Geospatial Information Systems software. Potential correlations were explored between pseudo-mass loads of the identified compounds and socioeconomic and demographic descriptors of the wastewater catchments derived from Census data. Markers of public health (e.g., cardiac arrhythmia, cardiovascular disease, anxiety disorder and type 2 diabetes) were identified in the wastewater samples by the proposed workflow. They were positively correlated with descriptors of disadvantage in education, occupation, marital status and income, and negatively correlated with descriptors of advantage in education and occupation. In addition, markers of polypropylene glycol (PPG) and polyethylene glycol (PEG) related compounds were positively correlated with housing and occupation disadvantage. High positive correlations were found between separated and divorced people and specific drugs used to treat cardiac arrhythmia, cardiovascular disease, and depression. Our robust non-targeted methodology in combination with Census data can identify relationships between biomarkers of public health, human behaviour and lifestyle and socio-demographics of whole populations. Furthermore, it can identify specific areas and socioeconomic groups that may need more assistance than others for public health issues. This approach complements important public health information and enables large-scale national coverage with a relatively small number of samples.

Back-estimation of norovirus infections through wastewater-based epidemiology: A systematic review and parameter sensitivity

The amount of norovirus RNA (Ribonucleic Acid) in raw wastewater, collected from a wastewater treatment plant (WWTP), can provide an indication of disease prevalence within the sampled catchment. However, an accurate back-estimation might be impeded by the uncertainties from in-sewer/in-sample degradation of viral RNA, variable shedding magnitude, and difficulties in measurement within raw wastewater. The current study reviewed the published literature regarding the factors of norovirus shedding, viral RNA decay in wastewater, and the occurrence of norovirus RNA in raw wastewater based on molecular detection. Sensitivity analysis for WBE back-estimation was conducted using the reported data of the factors mentioned above considering different viral loads in wastewater samples. It was found that the back-estimation is more sensitive to analytical detection uncertainty than shedding variability for norovirus. Although seasonal temperature change can lead to variation of decay rates and may influence the sensitivity of this pathogen-specific parameter, decay rates of norovirus RNA contribute negligibly to the variance in estimating disease prevalence, based on the available data from decay experiments in bulk wastewater under different temperatures. However, the effects of in-sewer transportation on viral RNA decay and retardation by sewer biofilms on pipe surfaces are largely unknown. Given the highest uncertainty from analytical measurement by molecular methods and complexity of in-sewer processes that norovirus experienced during the transportation to WWTP, future investigations are encouraged to improve the accuracy of viral RNA detection in wastewater and delineate viral retardation/interactions with wastewater biofilms in real sewers.

A nationwide wastewater-based assessment of metformin consumption across Australia

Metformin is the most widely used drug to treat type 2 diabetes. Monitoring spatial patterns of metformin use could provide new insights into treatment of type 2 diabetes and the distribution among populations. This study applied a wastewater-based epidemiological (WBE) approach to estimate metformin use in different populations across Australia and compared these estimates with traditional approaches of surveys and prescription data. Twenty-four-hour influent samples were collected from 75 wastewater treatment plants (WWTPs) across Australia in 2016 and analysed for metformin. Metformin was detected in all samples ranging in concentration from 8.2 to 191 µg/L (median 58 µg/L). Concentrations were converted to population-weighted average consumption at the national level, resulting in an average consumption of 28.6 g/day/1000 people across Australia, which was within 7% of estimates from national prescription statistics. In addition, results for five out of seven states had an estimated prevalence of type 2 diabetes within 20% compared to the traditional epidemiology surveys. Spatial patterns were also observed between urban and rural settings, with higher consumption rates of metformin found in Major Cities (22.5 ± 10.9 g/d/1000 people) and Inner Regional cities (25.4 ± 13.4 g/d/1000 people) than in Outer Regional (17.0 ± 8.1 g/d/1000 people) and Remote areas (15.1 ± 7.4 g/d/1000 people). Consumption estimates were also correlated against socioeconomic factors of the specific catchment areas. Greater metformin use was correlated with populations of lower education and income levels, while positive correlations were found between metformin consumption and consumption of allopurinol, caffeine and venlafaxine. Our study provides more evidence on the distribution of metformin use across Australia, which can be used to develop public health strategies to reduce the overall burden of type 2 diabetes in specific regions.

Basic influent sewage quality reflects sewershed characteristics in Tokyo city

Sewage comprises multifarious information on sewershed characteristics. For instance, influent sewage quality parameters (ISQPs) (e.g., total nitrogen (TN)) are being monitored regularly at all treatment plants. However, the relationship between ISQPs and sewershed characteristics is rarely investigated. Therefore, this study statistically investigated relationships between ISQPs and sewershed characteristics, covering demographic, social, and economic properties in Tokyo city as an example of a megacity. To this end, we collected ISQPs and sewershed characteristic data from 2015 to 2020 in 10 sewersheds in Tokyo city. By principal component analysis, spatial variability of ISQPs was aggregated into two principal components (89.8% contribution in total), indicating organics/nutrients and inorganic salts, respectively. Concentrations of organics/nutrients were significantly correlated with the population in sewersheds (daytime population density, family size, age distribution, etc.). Inorganic salts are significantly correlated with land cover ratios. Finally, a multiple regression model was developed for estimating the concentration of TN based on sewershed characteristics (R²=0.97). Scenario analysis using the regression model revealed that possible population movements in response to the coronavirus pandemic would substantially reduce the concentration of TN. These results indicate close relationships between ISQPs and sewershed characteristics and the potential applicability of big data of ISQPs to estimate sewershed characteristics and vice versa.

Interpreting per capita loads of organic matter and nutrients in municipal wastewater: A study on 168 Italian agglomerations

The size of an agglomeration is expressed in population equivalent, referring to the maximum average weekly load during the year according to the European Directive 271/91. This quantity, multiplied by the daily biochemical oxygen demand (BOD) produced by one population equivalent (which is 60 g d^-1 PE^-1, by definition), yields the design biodegradable organic load of the wastewater treatment plant. The same agglomeration size is compared against the capacity of the wastewater treatment plant (WWTP) for plant conformity verification by the European Commission. However, field observations show remarkable fluctuations of the daily mass flows entering a WWTP, often considerably below or above the expected load calculated according to the Directive prescriptions. A wrong estimation of the real influent load adversely affects the plant design and operation, and may lead to a misleading verification of its conformity to the agglomeration. In this work, a statistical data analysis on 168 agglomerations was performed, aiming at verifying the consistency between the expected loads of BOD, chemical oxygen demand (COD), nitrogen and phosphorus and the mass flows measured at the treatment plant inlet. Only 30-40% of the total analysed cases were found having an actual load compatible with the expected one. In these cases, the average per capita daily loads of BOD, COD, nitrogen and phosphorus, calculated over 2-3 years data pools, resulted: 44.6 ± 5.9, 82.4 ± 11, 9.4 ± 1.1, and 1.08 ± 0.13 g d^-1, respectively, while the daily BOD per capita production of 60 g represented a value in between the 70th and the 90th percentiles of the actual daily load distributions. For the remaining 60-70% of the total cases, variably-remarkable positive or negative discrepancies between the nominal pollutant loads generated by the agglomeration and those measured at the plant inlet could be detected and possible causes were pointed out.

Background release and potential point sources of per- and polyfluoroalkyl substances to municipal wastewater treatment plants across Australia

Wastewater treatment plants (WWTPs) are known to be significant sources of per- and polyfluoroalkyl substances (PFAS) to the environment. In this study, PFAS were measured in the influent of 76 municipal wastewater treatment plants (WWTPs) serving approximately 53% of the Australian population. Of fourteen target PFAS, twelve analytes including six C5-C10 perfluoroalkyl carboxylic acids (PFCAs), four C4-10 perfluoroalkyl sulfonic acids (PFSAs) and two fluorotelomer sulfonates (6:2 and 8:2 FTS) were detected. Of these, PFOS, PFHxS and PFHxA had the highest median concentrations. The per capita background release of Σ₁₂ PFAS to WWTP influent in Australia was estimated to be 8.1-24 μg/d/per person. The background release was supplemented by contributions from catchment specific point sources (i.e., industry, airports, military bases, and landfills), whereby the number of industrial sites positively correlated with the per capita mass load of Σ₁₂ PFAS (r = 0.5-0.63, p < 0.01). The per capita mass loads were extrapolated to the entire Australian population, with estimates suggesting that approximately 1 kg/d of Σ₁₂ PFAS reach WWTPs in Australia (300-400 kg annually), with more than half of the PFAS (∼59%) attributed to background release and the remaining (∼41%) to catchment specific point sources. These data provide insight into the release of major PFAS to wastewater at a national scale in Australia.

Does size matter? Quantification of plastics associated with size fractionated biosolids

This study investigated the occurrence and contribution of plastic particles associated with size fractionated biosolids to the total concentration in biosolids (treated sewage sludge) samples collected from 20 wastewater treatment plants (WWTP) across Australia. This was achieved through sequential size fractionation of biosolids samples to quantify the mass concentration of 7 common plastics across a range of biosolids size fractions, including below 25 μm which has not been assessed in many previous studies. Quantitative analysis was performed by pressurized liquid extraction followed by pyrolysis coupled to gas chromatography - mass spectrometry. Of the total quantified plastics (Σ₇plastics), the greatest proportion (27%) of the total mass were identified in the nominal <25 μm sized biosolids fraction. Polyethylene dominated the polymer mass in every size fraction, even though profiles varied between WWTPs. When comparing the sum of all sites for each sized biosolids fraction, the plurality of the polyethylene, polyvinyl-chloride, polystyrene, polypropylene, polycarbonate, and polyethylene-terephthalate concentrations were associated with the smallest size fraction (<25 μm). We confirm for the first time the presence of plastic particles in biosolids below a size fraction that is not captured by many methods. This is important, because of the potential greater significance of plastics in the low sizes to environmental and human health.

Temporal trends of perfluoroalkyl substances in an Australian wastewater treatment plant: A ten-year retrospective investigation

Per- and poly-fluoroalkyl substances (PFAS) are a problematic group of chemicals used in various industrial and household products. They have been extensively detected in wastewater as a result of day-to-day product usage. Due to concerns about their safety, voluntary and regulatory action to limit the manufacture and use of some individual PFAS has occurred since the year 2000. The impact that this intervention has had on the use and potential exposure of Australians has not been measured. Wastewater serves as a powerful tool to assess the chemical use or consumption patterns of a population over time. We accessed a ten-year wastewater archiving program to conduct a temporal analysis of PFAS trends in an urban Australian population between the years 2010 and 2020. Results showed a decline in the concentrations for most PFAS, and a change in the PFAS profile from perfluorosulfonic acids and long-chain perfluorocarboxylic acids, to the short-chain perfluorocarboxylic acids and PFOS-replacement degradation products such as 5:3 FTCA. Intermittent pulses of PFAS that were significantly higher than 'background' levels (i.e., representing the PFAS input from primarily households) were observed, suggesting continuing industrial PFAS input within the wastewater catchment. This study highlights the long-term consequences of the diffuse use of persistent chemicals in products, and their ability to continue to enter the wastewater stream for decades.

A nationwide indicator to smooth and normalize heterogeneous SARS-CoV-2 RNA data in wastewater

Since many infected people experience no or few symptoms, the SARS-CoV-2 epidemic is frequently monitored through massive virus testing of the population, an approach that may be biased and may be difficult to sustain in low-income countries. Since SARS-CoV-2 RNA can be detected in stool samples, quantifying SARS-CoV-2 genome by RT-qPCR in wastewater treatment plants (WWTPs) has been carried out as a complementary tool to monitor virus circulation among human populations. However, measuring SARS-CoV-2 viral load in WWTPs can be affected by many experimental and environmental factors. To circumvent these limits, we propose here a novel indicator, the wastewater indicator (WWI), that partly reduces and corrects the noise associated with the SARS-CoV-2 genome quantification in wastewater (average noise reduction of 19%). All data processing results in an average correlation gain of 18% with the incidence rate. The WWI can take into account the censorship linked to the limit of quantification (LOQ), allows the automatic detection of outliers to be integrated into the smoothing algorithm, estimates the average measurement error committed on the samples and proposes a solution for inter-laboratory normalization in the absence of inter-laboratory assays (ILA). This method has been successfully applied in the context of Obépine, a French national network that has been quantifying SARS-CoV-2 genome in a representative sample of French WWTPs since March 5th 2020. By August 26th, 2021, 168 WWTPs were monitored in the French metropolitan and overseas territories of France. We detail the process of elaboration of this indicator, show that it is strongly correlated to the incidence rate and that the optimal time lag between these two signals is only a few days, making our indicator an efficient complement to the incidence rate. This alternative approach may be especially important to evaluate SARS-CoV-2 dynamics in human populations when the testing rate is low.

Estimating dynamic population served by wastewater treatment plants using location-based services data

Wastewater-based epidemiology is a useful approach to estimate population-level exposure to a wide range of substances (e.g., drugs, chemicals, biological agents) by wastewater analysis. An important uncertainty in population normalized loads generated is related to the size and variability of the actual population served by wastewater treatment plants (WWTPs). Here, we built a population model using location-based services (LBS) data to estimate dynamic consumption of illicit drugs. First, the LBS data from Tencent Location Big Data and resident population were used to train a linear population model for estimating population (r² = 0.92). Then, the spatiotemporal accuracy of the population model was validated. In terms of temporal accuracy, we compared the model-based population with the time-aligned ammonia nitrogen (NH₄-N) population within the WWTP of SEG, showing a mean squared error of < 10%. In terms of spatial accuracy, we estimated the model-based population of 42 WWTPs in Dalian and compared it with the NH₄-N and design population, indicating good consistency overall (5% less than NH₄-N and 4% less than design). Furthermore, methamphetamine consumption and prevalence based on the model were calculated with an average of 111 mg/day/1000 inhabitants and 0.24%, respectively, and dynamically displayed on a visualization system for real-time monitoring. Our study provided a dynamic and accurate population for estimating the population-level use of illicit drugs, much improving the temporal and spatial trend analysis of drug use. Furthermore, accurate information on drug use could be used to assess population health risks in a community.

Quest for Optimal Regression Models in SARS-CoV-2 Wastewater Based Epidemiology

Wastewater-based epidemiology is a recognised source of information for pandemic management. In this study, we investigated the correlation between a SARS-CoV-2 signal derived from wastewater sampling and COVID-19 incidence values monitored by means of individual testing programs. The dataset used in the study is composed of timelines (duration approx. five months) of both signals at four wastewater treatment plants across Austria, two of which drain large communities and the other two drain smaller communities. Eight regression models were investigated to predict the viral incidence under varying data inputs and pre-processing methods. It was found that population-based normalisation and smoothing as a pre-processing of the viral load data significantly influence the fitness of the regression models. Moreover, the time latency lag between the wastewater data and the incidence derived from the testing program was found to vary between 2 and 7 days depending on the time period and site. It was found to be necessary to take such a time lag into account by means of multivariate modelling to boost the performance of the regression. Comparing the models, no outstanding one could be identified as all investigated models are revealing a sufficient correlation for the task. The pre-processing of data and a multivariate model formulation is more important than the model structure.

Performance- and image-enhancing drug use in the community: use prevalence, user demographics and the potential role of wastewater-based epidemiology

Performance- and image-enhancing drug (PIED) misuse is a significant public health issue. Currently, seizure data, surveys, anti-doping testing, and needle service provider data are used to estimate PIED use in populations. These methods are time consuming, single point-in-time measurements that often consist of small sample sizes and do not truly capture PIED prevalence. Wastewater-based epidemiology (WBE) has been used globally to assess and monitor licit and illicit drug consumption within the general community. This method can objectively cover large populations as well as specific subpopulations (gyms, music festivals, prisons), and has potential as a complementary monitoring method for PIED use. Information obtained through WBE could be used to aid public health authorities in developing targeted prevention and education programmes. Research on PIED analysis in wastewater is limited and presents a significant gap in the literature. The focus is on anabolic steroids, and one steroid alternative currently growing in popularity; selective androgenic receptor modulators. This encompasses medical uses, addiction, prevalence, user typology, and associated public health implications. An overview of WBE is described including its benefits, limitations and potential as a monitoring method for PIED use. A summary of previous work in this field is presented. Finally, we summarise gaps in the literature, future perspectives, and recommendations for monitoring PIEDs in wastewater.

Artificial sweeteners in end-use biosolids in Australia

Artificial sweeteners are contaminants of emerging concern that can enter the aquatic and terrestrial environments via wastewater effluent discharge and the environmental application of biosolids. The release of artificial sweeteners from the use of biosolids in Australia was assessed. The concentration of seven artificial sweeteners was quantified in biosolids samples collected from 71 wastewater treatment plants (WWTPs) across Australia during Census 2016. Sucralose, saccharin, acesulfame, aspartame and cyclamate were detected in biosolids samples at median concentrations ranging from 0.18 ng/g (dry weight) (range: <LOQ-34 ng/g) for cyclamate to 220 ng/g (range: <LOQ -3,670 ng/g) for sucralose, while neotame and neohesperidin dihydrochalcone were not detected. The relationship between the concentration of artificial sweeteners in biosolids and moisture content was assessed with the concentration of artificial sweeteners decreasing as dewatering time increased in a biosolids drying hall. The geometric means (± standard deviation) for per capita loads of individual artificial sweeteners ranged from 8.7 (1.6, 48) µg year^-1 person^-1 for cyclamate to 4,000 (1,000, 15,000) µg year^-1 person^-1 for sucralose with 223 kg of artificial sweeteners released to terrestrial environment from biosolids end-use annually in Australia. Due to the low loads of artificial sweeteners in biosolids compared with wastewater effluent, risks associated with artificial sweeteners in biosolids are likely limited.

Using Prescription and Wastewater Data to Estimate the Correction Factors of Atenolol, Carbamazepine, and Naproxen for Wastewater-Based Epidemiology Applications

The correction factor (CF) is a critical parameter in wastewater-based epidemiology (WBE) that significantly influences the accuracy of the final consumption estimates. However, most CFs have been derived from a few old pharmacokinetic studies and should be re-evaluated and refined to improve the accuracy of the WBE approach. This study aimed to review and estimate the CFs for atenolol, carbamazepine, and naproxen for WBE using the daily mass loads of those pharmaceuticals in wastewater and their corresponding dispensed prescription data in Australia. Influent wastewater samples were collected from wastewater treatment plants serving approximately 24% of the Australian population and annual national dispensed prescription data. The estimated CFs for atenolol and carbamazepine are 1.37 (95% CI: 1.17-1.66) and 8.69 (95% CI: 7.66-10.03), respectively. Due to significant over-the-counter sales of naproxen, a reliable CF could not be estimated based on prescription statistics. Using an independent dataset of 186 and 149 wastewater samples collected in an urban catchment in 2011 and 2012, WBE results calculated using the new CFs matched well with the dispensed data for atenolol and carbamazepine in the catchment area.

Catching a resurgence: Increase in SARS-CoV-2 viral RNA identified in wastewater 48 h before COVID-19 clinical tests and 96 h before hospitalizations

Curtailing the Spring 2020 COVID-19 surge required sweeping and stringent interventions by governments across the world. Wastewater-based COVID-19 epidemiology programs have been initiated in many countries to provide public health agencies with a complementary disease tracking metric and non-discriminating surveillance tool. However, their efficacy in prospectively capturing resurgences following a period of low prevalence is unclear. In this study, the SARS-CoV-2 viral signal was measured in primary clarified sludge harvested every two days at the City of Ottawa's water resource recovery facility during the summer of 2020, when clinical testing recorded daily percent positivity below 1%. In late July, increases of >400% in normalized SARS-CoV-2 RNA signal in wastewater were identified 48 h prior to reported >300% increases in positive cases that were retrospectively attributed to community-acquired infections. During this resurgence period, SARS-CoV-2 RNA signal in wastewater preceded the reported >160% increase in community hospitalizations by approximately 96 h. This study supports wastewater-based COVID-19 surveillance of populations in augmenting the efficacy of diagnostic testing, which can suffer from sampling biases or timely reporting as in the case of hospitalization census.

Catching a resurgence: Increase in SARS-CoV-2 viral RNA identified in wastewater 48 h before COVID-19 clinical tests and 96 h before hospitalizations

Curtailing the Spring 2020 COVID-19 surge required sweeping and stringent interventions by governments across the world. Wastewater-based COVID-19 epidemiology programs have been initiated in many countries to provide public health agencies with a complementary disease tracking metric and non-discriminating surveillance tool. However, their efficacy in prospectively capturing resurgences following a period of low prevalence is unclear. In this study, the SARS-CoV-2 viral signal was measured in primary clarified sludge harvested every two days at the City of Ottawa's water resource recovery facility during the summer of 2020, when clinical testing recorded daily percent positivity below 1%. In late July, increases of >400% in normalized SARS-CoV-2 RNA signal in wastewater were identified 48 h prior to reported >300% increases in positive cases that were retrospectively attributed to community-acquired infections. During this resurgence period, SARS-CoV-2 RNA signal in wastewater preceded the reported >160% increase in community hospitalizations by approximately 96 h. This study supports wastewater-based COVID-19 surveillance of populations in augmenting the efficacy of diagnostic testing, which can suffer from sampling biases or timely reporting as in the case of hospitalization census.

Application of catecholamine metabolites as endogenous population biomarkers for wastewater-based epidemiology

Wastewater-based epidemiology studies use catchment populations to normalise chemical marker mass loads in 24-h composite wastewater samples. However, one of the biggest uncertainties within the field is the accuracy of the population used. A population marker in wastewater may significantly reduce the uncertainty. This study evaluated the catecholamine metabolites - homovanillic acid (HVA) and vanillylmandelic acid (VMA) - as potential population biomarkers. Influent wastewater 24-h composite samples were collected from 38 wastewater catchments from around Australia (representing ~33% of Australia's population), extracted and analysed by liquid chromatography tandem mass spectrometry. Measured mass loads were compared to population sizes determined by mapping catchment maps against high-resolution census data. Both biomarkers correlated with coefficient of determinations (r²) of 0.908 and 0.922 for HVA and VMA, respectively. From the regression analysis, a slope (i.e. the daily per-capita excretion) of 1.241 and 1.067 mg.day^-1.person^-1 was obtained for HVA and VMA, respectively. The mass load ratio between VMA:HVA were very similar to that reported in literature for urinary analysis among all catchments. Overall, this study provided further evidence that catecholamine metabolites are suitable candidates as population biomarkers for future studies.

Wastewater-based prevalence trends of gout in an Australian community over a period of 8 years

Gout is a rheumatic arthritis disease which poses a health burden. Monitoring the prevalence of gout is key to reduce the community burden of gout disease and associated health costs. Allopurinol has been used as a first line gout preventive medication in Australia which is metabolised into oxypurinol and excreted in urine. Wastewater-based epidemiology (WBE) was applied to estimate temporal trends of gout prevalence in an Australian community over eight-years via the quantification of oxypurinol in wastewater. A total of 180 wastewater samples collected between 2012 and 2019 were analysed for oxypurinol to estimate allopurinol consumption in a community in South East Queensland, Australia. Annual gout prevalence was estimated by daily defined doses (DDD) consumed and ranged from 24 to 32 DDD/day/1000, an equivalent gout prevalence of 2.3 to 3.2% over the eight-year period. A statistically significant increase in allopurinol consumption was observed over the period (Slope = 0.094, p = 0.0001), equating to year-on-year increases in gout prevalence of 3.6% per year. To the best of our knowledge, this is the first long-term gout prevalence study using wastewater, adding epidemiological and public health insights in the gout research field.

Monitoring drug consumption in Innsbruck during coronavirus disease 2019 (COVID-19) lockdown by wastewater analysis

The coronavirus disease 2019 (COVID-19) has developed into a serious pandemic with millions of cases diagnosed worldwide. To fight COVID-19 pandemic, over 100 countries instituted either a full or partial lockdown, affecting billions of people. In Tyrol, first lockdown measures were taken on 10 March 2020. On 16 March 2020, a curfew went into force which ended on 1 May 2020. On 19 March 2020, Tyrol as a whole was placed in quarantine which ended on 7 April 2020. The governmental actions helped reducing the spread of COVID-19 at the cost of significant effects on social life and behaviour. Accordingly, to provide a comprehensive picture of the population health status not only input from medical and biological sciences is required, but also from other sciences able to provide lifestyle information such as drug use. Herein, wastewater-based epidemiology was used for studying temporal trends of licit and illicit drug consumption during lockdown and quarantine in the area of the Tyrolean capital Innsbruck (174,000 inhabitants). On 35 days between 12 March 2020 and 15 April 2020, loads of 23 markers were monitored in wastewater. Loads determined on 292 days between March 2016 and January 2020 served as reference. During lockdown, changes in the consumption patterns of recreational drugs (i.e. cocaine, amphetamine, 3,4-methylenedioxymethamphetamine, methamphetamine, and alcohol) and pharmaceuticals for short-term application (i.e. acetaminophen, codeine, and trimethoprim) were detected. For illicit drugs and alcohol, it is very likely that observed changes were linked to the shutdown of the hospitality industry and event cancelation which led to a reduced demand of these compounds particularly on weekends. For the pharmaceuticals, further work will be necessary to clarify if the observed declines are indicators of improved population health or of some kind of restraining effect that reduced the number of consultations of medical doctors and pharmacies.

Trends in artificial sweetener consumption: A 7-year wastewater-based epidemiology study in Queensland, Australia

A 7-year temporal trend study of artificial sweetener consumption was performed by determining per capital mass loads in 293 influent wastewater samples collected from a wastewater treatment plant in Australia between 2012 and 2018. Population-weighted per capita mass loads of the four detected artificial sweeteners ranged from 2.4 ± 0.8 mg d^-1 p^-1 for saccharin to 7.8 ± 2.0 mg d^-1 p^-1 for acesulfame over the study period. Negligible intra-week fluctuations were observed, however the consumption of acesulfame was seen to be significantly influenced by season with the highest consumption in summer. The consumption of sucralose and saccharin significantly increased with an annual increase rate of 10% and 6.0%. Cyclamate consumption declined over the same period with average annual decrease rate of 11%, which agrees with data from market surveys. Sucrose equivalence of total artificial sweeteners consumption showed an increase between 2012 and 2016, then decreased in 2018. This is the first long-term trend study of artificial sweetener consumption by wastewater analysis and highlights the feasibility to quantitatively measure artificial sweeter consumption over time.

Wastewater treatment efficacy evaluated with in vitro bioassays

Bioassays show promise as a complementary approach to chemical analysis to assess the efficacy of wastewater treatment processes as they can detect the mixture effects of all bioactive chemicals in a sample. We investigated the treatment efficacy of ten Australian wastewater treatment plants (WWTPs) covering 42% of the national population over seven consecutive days. Solid-phase extracts of influent and effluent were subjected to an in vitro test battery with six bioassays covering nine endpoints that captured the major modes of action detected in receiving surface waters. WWTP influents and effluents were compared on the basis of population- and flow-normalised effect loads, which provided insights into the biological effects exhibited by the mixture of chemicals before and after treatment. Effect removal efficacy varied between effect endpoints and depended on the treatment process. An ozonation treatment step had the best treatment efficacy, while WWTPs with only primary treatment resulted in poor removal of effects. Effect removal was generally better for estrogenic effects and the peroxisome proliferator-activated receptor than for inhibition of photosynthesis, which is consistent with the persistence of herbicides causing this effect. Cytotoxicity and oxidative stress response provided a sum parameter of all bioactive chemicals including transformation products and removal was poorer than for specific endpoints except for photosynthesis inhibition. Although more than 500 chemicals were analysed, the detected chemicals explained typically less than 10% of the measured biological effect, apart from algal toxicity, where the majority of the effect could be explained by one dominant herbicide, diuron. Overall, the current study demonstrated the utility of applying bioassays alongside chemical analysis to evaluate loads of chemical pollution reaching WWTPs and treatment efficacy.

Long-term trends in tobacco use assessed by wastewater-based epidemiology and its relationship with consumption of nicotine containing products

Measurement of population tobacco use via wastewater-based epidemiology (WBE) provides objective data to evaluate the efficacy of tobacco control strategies. However, current WBE tobacco-use estimates based on nicotine metabolites (cotinine and hydroxycotinine) can be masked by use of non-tobacco nicotine-containing products. To better understand nicotine and tobacco use, we analysed tobacco-specific biomarkers, anabasine and anatabine, as well as nicotine metabolites, cotinine and hydroxycotinine, in wastewater samples collected for 6 weeks per year over 6 years (2012-2017) from an Australian wastewater treatment plant serving approximately 100,000 people. Population-normalised mass loads were used to estimate tobacco and nicotine use trends and were compared with surveys and taxation statistics. Significant annual declines were observed for anabasine, anatabine, cotinine and hydroxycotinine of -3.0%, -2.7%, -2.4%, and -2.1%, respectively. The results corresponded with the annual declining trends reported from surveys (-5%) and taxation statistics (-4%). Significant annual decreases in the ratios of anabasine to cotinine (-1.2%) and anatabine to cotinine (-1.0%) suggested a relative increase in the use of non-tobacco nicotine products at the same time that tobacco use was declining. Monitoring tobacco use with anabasine and anatabine removed influence from nicotine-containing products, showing larger reductions in this Australian city than via nicotine biomarkers, whilst also demonstrating their suitability for monitoring long-term trends.

Release of Plastics to Australian Land from Biosolids End-Use

Plastics are contaminants of emerging concern that can enter the environment from multiple sources, including via land application of treated sewage sludge (biosolids). Biosolids samples collected from 82 wastewater treatment plants (WWTPs) across Australia and covering 34% of the population during census week in 2016 were quantitatively analyzed to estimate the release of seven common plastics. Quantitative analysis was performed by pressurized liquid extraction followed by double-shot microfurnace pyrolysis coupled to gas chromatography mass spectrometry. Ninety nine percent of the samples contained plastics (Σ₆plastics) at concentrations of between 0.4 and 23.5 mg/g dry weight (median; 10.4 mg/g dry weight), while polycarbonate was not detected in any sample. Per-capita mass loads of plastics (Σ₆plastics) released were between 8 and 877 g/person/year across all investigated WWTPs. Polyethylene was the predominant plastic detected, contributing to 69% of Σ₆plastics. Based on the concentrations measured, it was projected that around 4700 metric tons (Mt) of plastics are released into the Australian environment through biosolids end-use each year, equating to approximately 200 g/person/year, which represents 0.13% of total plastics use in Australia. Of this, 3700 Mt of plastics are released to agricultural lands and 140 Mt to landscape topsoil. Our results provide a first quantitative per-capita mass loads and emission estimate of plastic types through biosolids end-use.

High-throughput wastewater analysis for substance use assessment in central New York during the COVID-19 pandemic

Wastewater entering sewer networks represents a unique source of pooled epidemiological information. In this study, we coupled online solid-phase extraction with liquid chromatography-high resolution mass spectrometry to achieve high-throughput analysis of health and lifestyle-related substances in untreated municipal wastewater during the coronavirus disease 2019 (COVID-19) pandemic. Twenty-six substances were identified and quantified in influent samples collected from six wastewater treatment plants during the COVID-19 pandemic in central New York. Over a 12 week sampling period, the mean summed consumption rate of six major substance groups (i.e., antidepressants, antiepileptics, antihistamines, antihypertensives, synthetic opioids, and central nervous system stimulants) correlated with disparities in household income, marital status, and age of the contributing populations as well as the detection frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater and the COVID-19 test positivity in the studied sewersheds. Nontarget screening revealed the covariation of piperine, a nontarget substance, with SARS-CoV-2 RNA in wastewater collected from one of the sewersheds. Overall, this proof-of-the-concept study demonstrated the utility of high-throughput wastewater analysis for assessing the population-level substance use patterns during a public health crisis such as COVID-19.

What is the drug of choice of young festivalgoers?

BACKGROUND

Drug and alcohol consumption are commonplace at festivals including those aimed at younger attendees. However, there is little quantitative information about the extent of this consumption. This work investigates drug use at a school-leaver festival and how it compares to non-festival weeks.

METHODS

Influent wastewater was collected over three consecutive weeks from a location where a school-leaver festival occurs. Multiple liquid chromatography-mass spectrometry methods were used to analyse the use of illicit drugs, pharmaceuticals with abuse potential, new psychoactive substances (NPS), alcohol and cannabis. A method for human neurotransmitter metabolites was also utilised to show the population change and allow the drugs found to be normalised to a population.

RESULTS

A total of 12 compounds were quantifiable: methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), alcohol, cannabis, cocaine, morphine, codeine, fentanyl, buprenorphine, oxycodone and nicotine. The NPS methylone was found solely over the festival weekend but at levels below the limit of quantification of the analytical method. The catecholamine metabolites vanillylmandelic acid (VMA) and homovanillic acid (HVA) were found over the entire three weeks, with identical trends - an increase over the festival weekend - indicating a population increase. HVA was used to normalise the drug mass loads to derive a population normalised mass load. Statistical differences using Hedges' g showed large changes in the use of MDMA and MDA over the festival week. Smaller increases were also seen for alcohol and cocaine.

CONCLUSIONS

The drugs of choice for the attendees of this school-leaver festival were MDMA and MDA.

National wastewater reconnaissance of artificial sweetener consumption and emission in Australia

Artificial sweeteners are used as sugar substitutes in our daily lives yet consumption and release patterns are currently unknown in Australia. The spatial distribution of artificial sweetener consumption and WWTP effluent emission in Australia was estimated by wastewater analysis. Wastewater influent and effluent samples were collected from 69 WWTPs across Australia during the week of the 2016 Australian census. Mean population-weighted per capita loads for individual artificial sweeteners (cyclamate, aspartame, acesulfame, sucralose, saccharin) ranged from 0.12 ± 0.14 mg d^-1p^-1 for aspartame to 6.9 ± 2.8 mg d^-1p^-1 for acesulfame with 1004 kg of these artificial sweeteners being consumed daily in Australia. Significant removal of aspartame (100%), cyclamate (92 ± 18%) and saccharin (88 ± 21%) was observed during wastewater treatment. The average per capita release to the environment for individual artificial sweeteners (cyclamate, acesulfame, sucralose, saccharin) ranged from 230 ± 780 mg d^-1 1000p^-1 (cyclamate) to 3800 ± 1400 mg d^-1 1000p^-1 (sucralose). The daily release of artificial sweeteners from Australian WWTPs was estimated to be 142 kg suggesting that 14% of the artificial sweeteners consumed in Australia are released into the environment. To the best of our knowledge, this is the first wastewater study to estimate the occurrence and population-normalized artificial sweetener consumption and emission in Australia.

Implementation of environmental surveillance for SARS-CoV-2 virus to support public health decisions: Opportunities and challenges

Analysing wastewater can be used to track infectious disease agents that are shed via stool and urine. Sewage surveillance of SARS-CoV-2 has been suggested as a tool to determine the extent of COVID-19 in cities and serve as an early warning for (re-)emergence of SARS-CoV-2 circulation in communities. The focus of this review is on the strength of evidence, opportunities and challenges for the application of sewage surveillance to inform public health decision making. Considerations for undertaking sampling programs are reviewed including sampling sites, strategies, sample transport, storage and quantification methods; together with the approach and evidence base for quantifying prevalence of infection from measured wastewater concentration. Published SARS-CoV-2 sewage surveillance studies (11 peer reviewed and 10 preprints) were reviewed to demonstrate the current status of implementation to support public health decisions. Although being very promising, a number of areas were identified requiring additional research to further strengthen this approach and take full advantage of its potential. In particular, design of adequate sampling strategies, spatial and temporal resolution of sampling, sample storage, replicate sampling and analysis, controls for the molecular methods used for the quantification of SARS-CoV-2 RNA in wastewater. The use of appropriate prevalence data and methods to correlate or even translate SARS-CoV-2 concentrations in wastewater to prevalence of virus shedders in the population is discussed.

Do food and stress biomarkers work for wastewater-based epidemiology? A critical evaluation

Dietary characteristics and oxidative stress are closely linked to the wellbeing of individuals. In recent years, various urinary biomarkers of food and oxidative stress have been proposed for use in wastewater-based epidemiology (WBE), in efforts to objectively monitor the food consumed and the oxidative stress experienced by individuals in a wastewater catchment. However, it is not clear whether such biomarkers are suitable for wastewater-based epidemiology. This study presents a suite of 30 urinary food and oxidative stress biomarkers and evaluates their applicability for WBE studies. This includes 22 biomarkers which were not previously considered for WBE studies. Daily per capita loads of biomarkers were measured from 57 wastewater influent samples from nine Australian catchments. Stability of biomarkers were assessed using laboratory scale sewer reactors. Biomarkers of consumption of vitamin B2, vitamin B3 and fibre, as well as a component of citrus had per capita loads in line with reported literature values despite susceptibility of degradation in sewer reactors. Consumption biomarkers of red meat, fish, fruit, other vitamins and biomarkers of stress had per capita values inconsistent with literature findings, and/or degraded rapidly in sewer reactors, indicating that they are unsuitable for use as WBE biomarkers in the traditional quantitative sense. This study serves to communicate the suitability of food and oxidative stress biomarkers for future WBE research.

First confirmed detection of SARS-CoV-2 in untreated wastewater in Australia: A proof of concept for the wastewater surveillance of COVID-19 in the community

Infection with SARS-CoV-2, the etiologic agent of the ongoing COVID-19 pandemic, is accompanied by the shedding of the virus in stool. Therefore, the quantification of SARS-CoV-2 in wastewater affords the ability to monitor the prevalence of infections among the population via wastewater-based epidemiology (WBE). In the current work, SARS-CoV-2 RNA was concentrated from wastewater in a catchment in Australia and viral RNA copies were enumerated using reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) resulting in two positive detections within a six day period from the same wastewater treatment plant (WWTP). The estimated viral RNA copy numbers observed in the wastewater were then used to estimate the number of infected individuals in the catchment via Monte Carlo simulation. Given the uncertainty and variation in the input parameters, the model estimated a median range of 171 to 1,090 infected persons in the catchment, which is in reasonable agreement with clinical observations. This work highlights the viability of WBE for monitoring infectious diseases, such as COVID-19, in communities. The work also draws attention to the need for further methodological and molecular assay validation for enveloped viruses in wastewater.