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Li X, Kulandaivelu J, Guo Y, Zhang S, Shi J, O'Brien J, Arora S, Kumar M, Sherchan SP, Honda R, Jackson G, Luby SP, Jiang G. SARS-CoV-2 shedding sources in wastewater and implications for wastewater-based epidemiology. JOURNAL OF HAZARDOUS MATERIALS 2022; 432:128667. [PMID: 35339834 PMCID: PMC8908579 DOI: 10.1016/j.jhazmat.2022.128667] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 05/21/2023]
Abstract
Wastewater-based epidemiology (WBE) approach for COVID-19 surveillance is largely based on the assumption of SARS-CoV-2 RNA shedding into sewers by infected individuals. Recent studies found that SARS-CoV-2 RNA concentration in wastewater (CRNA) could not be accounted by the fecal shedding alone. This study aimed to determine potential major shedding sources based on literature data of CRNA, along with the COVID-19 prevalence in the catchment area through a systematic literature review. Theoretical CRNA under a certain prevalence was estimated using Monte Carlo simulations, with eight scenarios accommodating feces alone, and both feces and sputum as shedding sources. With feces alone, none of the WBE data was in the confidence interval of theoretical CRNA estimated with the mean feces shedding magnitude and probability, and 63% of CRNA in WBE reports were higher than the maximum theoretical concentration. With both sputum and feces, 91% of the WBE data were below the simulated maximum CRNA in wastewater. The inclusion of sputum as a major shedding source led to more comparable theoretical CRNA to the literature WBE data. Sputum discharging behavior of patients also resulted in great fluctuations of CRNA under a certain prevalence. Thus, sputum is a potential critical shedding source for COVID-19 WBE surveillance.
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Affiliation(s)
- Xuan Li
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Australia
| | | | - Ying Guo
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Australia
| | - Shuxin Zhang
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Australia
| | - Jiahua Shi
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, Australia
| | - Jake O'Brien
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woollongabba, Queensland 4072, Australia
| | - Sudipti Arora
- Dr. B. Lal Institute of Biotechnology, 6E, Malviya Industrial Area, Malviya Nagar, Jaipur 302017, India
| | - Manish Kumar
- Sustainability Cluster, School of Engineering, University of Petroleum & Energy Studies, Dehradun, Uttarakhand 248007, India
| | - Samendra P Sherchan
- Department of Environmental health sciences, Tulane University, New Orleans, LA 70112, USA; Bioenvironmental Science Program, Morgan Staate University, Baltimore, MD 21251, USA
| | - Ryo Honda
- Faculty of Geosciences and Civil Engineering, Kanazawa University, Kanazawa 920-1192, Japan
| | - Greg Jackson
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woollongabba, Queensland 4072, Australia
| | - Stephen P Luby
- Stanford Center for Innovation in Global Health, and Stanford Woods Institute for the Environment, Stanford University, Stanford, CA 94305, USA
| | - Guangming Jiang
- School of Civil, Mining and Environmental Engineering, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, Australia.
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Ünsaler S, Okan A, Tekin S, Hafız AM, Gökler O, Altuntaş O. Comparison of nasopharyngeal swab and nasopharyngeal aspiration in adults for SARS-CoV-2 identification using reverse transcription-polymerase chain reaction. J Med Virol 2021; 93:6693-6695. [PMID: 34331714 PMCID: PMC8426860 DOI: 10.1002/jmv.27250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022]
Abstract
We aimed to compare reverse transcription‐polymerase chain reaction (RT‐PCR) results of nasopharyngeal aspiration (NA) and nasopharyngeal swab (NS) samples in the diagnosis of coronavirus disease 2019. NS was obtained with a dacron swab and NA was performed by aspiration cannula. The sampling was performed by an otolaryngologist to ensure standardized correct sampling from the nasopharynx. RT‐PCR was performed for the detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The level of agreement between the result of NA and NS samples for each patient was analyzed. The Ct values were compared. Thirty‐three patients were enrolled in the study with a mean age of 56.3 years. Thirteen subjects resulted negative with both NS and NA; 20 subjects resulted positive with NA and 18 subjects resulted positive with NS. The mean values of Ct for NA samples and NS samples were 24.6 ± 5.9 and 24 ± 6.7, respectively. There was no statistical difference between Ct values of NA and NS samples (p = 0.48). RT‐PCR for SARS‐Cov2 performed with NA sample and NS sample showed a strong correlation regarding the positivity/negativity and the Ct values. The results demonstrated that RT–PCR for SARS–Cov2 performed with NA sample and NS sample showed a strong correlation regarding the positivity and negativity and the Ct values. It is less likely to obtain an insufficient amount of material with NA than that with NS. Therefore, NA may be preferred for the second sampling, especially in patients who are difficult to be sampled with swab because of a septal deviation or patient incompatibility.
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Affiliation(s)
- Selin Ünsaler
- Department of Otolaryngology, Koç University School of Medicine, Istanbul, Turkey
| | - Ayşe Okan
- Department of Microbiology, Division of Molecular Microbiology, Koç University Hospital, Istanbul, Turkey
| | - Süda Tekin
- Department of Clinical Microbiology and Infectious Diseases, Koç University School of Medicine, Istanbul, Turkey
| | - Ayşenur M Hafız
- Department of Otolaryngology, Koç University School of Medicine, Istanbul, Turkey
| | - Ozan Gökler
- Department of Otolaryngology, Koç University School of Medicine, Istanbul, Turkey
| | - Ozan Altuntaş
- Department of Otolaryngology, Koç University School of Medicine, Istanbul, Turkey
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Amereh F, Negahban-Azar M, Isazadeh S, Dabiri H, Masihi N, Jahangiri-Rad M, Rafiee M. Sewage Systems Surveillance for SARS-CoV-2: Identification of Knowledge Gaps, Emerging Threats, and Future Research Needs. Pathogens 2021. [PMID: 34451410 DOI: 10.3390/pathogens10080946.pmid:34451410;pmcid:pmc8402176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
The etiological agent for novel coronavirus (COVID-19, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), not only affects the human respiratory system, but also the gastrointestinal tract resulting in gastrointestinal manifestations. The high rate of asymptomatic infected individuals has challenged the estimation of infection spread based on patients' surveillance, and thus alternative approaches such as wastewater-based epidemiology (WBE) have been proposed. Accordingly, the number of publications on this topic has increased substantially. The present systematic review thus aimed at providing state-of-the-knowledge on the occurrence and existing methods for sampling procedures, detection/quantification of SARS-CoV-2 in sewage samples, as well as anticipating challenges and providing future research direction to improve the current scientific knowledge. Articles were collected from three scientific databases. Only studies reporting measurements of virus in stool, urine, and wastewater samples were included. Results showed that improving the scientific community's understanding in these avenues is essential if we are to develop appropriate policy and management tools to address this pandemic pointing particularly towards WBE as a new paradigm in public health. It was also evident that standardized protocols are needed to ensure reproducibility and comparability of outcomes. Areas that require the most improvements are sampling procedures, concentration/enrichment, detection, and quantification of virus in wastewater, as well as positive controls. Results also showed that selecting the most accurate population estimation method for WBE studies is still a challenge. While the number of people infected in an area could be approximately estimated based on quantities of virus found in wastewater, these estimates should be cross-checked by other sources of information to draw a more comprehensive conclusion. Finally, wastewater surveillance can be useful as an early warning tool, a management tool, and/or a way for investigating vaccination efficacy and spread of new variants.
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Affiliation(s)
- Fatemeh Amereh
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran
| | - Masoud Negahban-Azar
- Department of Environmental Science and Technology, University of Maryland, College Park, MD 20740, USA
| | - Siavash Isazadeh
- Environmental Service, Suez Water North America, Paramus, NJ 07652, USA
| | - Hossein Dabiri
- Department of Medical Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran
| | - Najmeh Masihi
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran
| | - Mahsa Jahangiri-Rad
- Water Purification Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran 19168, Iran
| | - Mohammad Rafiee
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran
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Amereh F, Negahban-Azar M, Isazadeh S, Dabiri H, Masihi N, Jahangiri-rad M, Rafiee M. Sewage Systems Surveillance for SARS-CoV-2: Identification of Knowledge Gaps, Emerging Threats, and Future Research Needs. Pathogens 2021; 10:946. [PMID: 34451410 PMCID: PMC8402176 DOI: 10.3390/pathogens10080946] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/04/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
The etiological agent for novel coronavirus (COVID-19, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), not only affects the human respiratory system, but also the gastrointestinal tract resulting in gastrointestinal manifestations. The high rate of asymptomatic infected individuals has challenged the estimation of infection spread based on patients' surveillance, and thus alternative approaches such as wastewater-based epidemiology (WBE) have been proposed. Accordingly, the number of publications on this topic has increased substantially. The present systematic review thus aimed at providing state-of-the-knowledge on the occurrence and existing methods for sampling procedures, detection/quantification of SARS-CoV-2 in sewage samples, as well as anticipating challenges and providing future research direction to improve the current scientific knowledge. Articles were collected from three scientific databases. Only studies reporting measurements of virus in stool, urine, and wastewater samples were included. Results showed that improving the scientific community's understanding in these avenues is essential if we are to develop appropriate policy and management tools to address this pandemic pointing particularly towards WBE as a new paradigm in public health. It was also evident that standardized protocols are needed to ensure reproducibility and comparability of outcomes. Areas that require the most improvements are sampling procedures, concentration/enrichment, detection, and quantification of virus in wastewater, as well as positive controls. Results also showed that selecting the most accurate population estimation method for WBE studies is still a challenge. While the number of people infected in an area could be approximately estimated based on quantities of virus found in wastewater, these estimates should be cross-checked by other sources of information to draw a more comprehensive conclusion. Finally, wastewater surveillance can be useful as an early warning tool, a management tool, and/or a way for investigating vaccination efficacy and spread of new variants.
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Affiliation(s)
- Fatemeh Amereh
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran; (F.A.); (N.M.)
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran
| | - Masoud Negahban-Azar
- Department of Environmental Science and Technology, University of Maryland, College Park, MD 20740, USA
| | - Siavash Isazadeh
- Environmental Service, Suez Water North America, Paramus, NJ 07652, USA;
| | - Hossein Dabiri
- Department of Medical Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran;
| | - Najmeh Masihi
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran; (F.A.); (N.M.)
| | - Mahsa Jahangiri-rad
- Water Purification Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran 19168, Iran;
| | - Mohammad Rafiee
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran; (F.A.); (N.M.)
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran 35511, Iran
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