- submitted 2022-11-15 (Science Monthly), accepted 2022-12-02,
- published as "Use wastewater to monitor viruses and bacteria! Wastewater Epidemiology" , Science Monthly, No. 640. pp.60-63, 2023-04-01
- DOIs: https://doi.org/10.6084/m9.figshare.23540997 ; https://doi.org/10.5281/zenodo.8054581
Professor Marlene Wolfe, one of the leaders of the US Sewer Coronavirus Alert Network (SCAN) team, said in an interview with the British Medical Journal: “We can take that sample, which is less than a gram of wastewater solids, from communities all across the country: that small sample can represent up to 4 million people in some cases.”.
The whisper of SARS-CoV-2
was loud in less than a gram of wastewater sample. At the end of 2022, more
than 3,800 monitoring stations in at least 70 countries around the world are
watching the wind and listening to the whisper of SARS-CoV-2 in the water.
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Figure 1: History of Wastewater Science Terminology |
History of Wastewater Science Terminology
The origin of the detected wastewater can be traced back to the Broad Street cholera outbreak in Soho, London in 1854. At that time, in a public well and cesspool near a house where many people died of cholera, feces were found to leak bacteria and contaminate the water supply system of the pump, causing an epidemic.
- In the mid-1950s, "Wastewater Tracing or Tracking" appeared successively after the research on the wastewater infected by snail schistosomiasis in South Africa.
- Around 1970s, "wastewater monitoring" and "wastewater surveillance, "WWS)" or "Wastewater-Based Surveillance (WBS)" are commonly used in industrial wastewater detection research.
- In the 2000s,
issues such as tracking heroin and other illicit drugs emerged as "sewage
epidemiology" and "wastewater-based epidemiology (WBE)". The
mixed use of subject terms mainly describes the scientific based on the premise
that the substances excreted by humans in wastewater can be used to calculate
the initial concentration.
However, by 2014,
the term "wastewater epidemiology" gradually replaced the term
"sewage epidemiology". Although the terms sewage and wastewater are
still commonly used interchangeably, the recent official documents of the World
Health Organization (WHO) mainly use the term "wastewater surveillance". Scholars also suggested the standardization of related
science and technology, and supported the use of "wastewater surveillance
(WWS)" and "wastewater epidemiology (WBE)" as common terms.
If we examine the differences in definitions, we can distinguish them from the perspective of public health (Figure 1):
- wastewater tracing or tracking is mainly to identify the source of pathogens or toxins;
- wastewater monitoring is an action to ensure that waste water discharge does not cause public health risks ;
- wastewater surveillance emphasizes systematic, continuous testing of wastewater for the benefit of public health and may be relevant for public health policy;
- wastewater epidemiology (WBE) is the scientific field that links pathogens and chemicals found in wastewater to population health.
Which infectious human pathogens were
studied in wastewater before COVID-19?
Wastewater surveillance (WWS) has been used to assess waterborne and fecal-oral
pathogens that cause diarrhea-related diseases. The well-studied pathogens of
human infectious diseases include picornaviridae, caliciviridae and reoviridae,
etc. (indicated by * in Fig. 2). Epidemics of international concern such as
coronavirus, Ebola virus, Zika fever, and polio/poliomyelitis virus (indicated
by *** in Figure 2) have provided information on public health actions or
policies, but influenza is rare founded in WWS literature.
 |
| Figure 2: Wastewater Surveillance (WWS) of known infectious diseases before the COVID-19 pandemic: virus classification by family/genus |
If the coronavirus
is the subject, the early coronavirus wastewater monitoring is in view of the
emergence of new viruses with high epidemic potential, which usually involves
complex dynamic effects on animals, humans and the environment. Therefore,
since the 1970s, environmental monitoring has been implemented by monitoring
surface water, mud and biosolids to understand
the status of such viruses in the water cycle, ex. human coronavirus
(HCoV), human coronavirus 229E (CoV-229E), HKU1 and severe acute respiratory
syndrome coronavirus (SARS-CoV); zoonotic coronaviruses such as Middle East
respiratory syndrome coronavirus (MERS-CoV) and animal coronaviruses: such as
bovine coronavirus (BCoV), mouse hepatitis virus (MHV), etc. This stage focuses
on coronavirus, the survival status of viruses in wastewater and the efficiency
of virus recovery, etc., but the overall knowledge is still very scarce and
fragmented.
After the COVID-19 pandemic
 |
| Figure 3: Overview of Wastewater Surveillance (WWS) after COVID-19 |
The COVID-19 pandemic has seen extensive adaptation of global wastewater surveillance (WWS), and wastewater can also be an effective potential application for surveillance of respiratory-transmitted pathogens. Technologies for detecting SARS-CoV-2 and new variants through wastewater are becoming more sophisticated.
Figure 3
generally illustrates the current WWS in addition to early development of
chemicals such as drugs, cleaning agents, industrial pollutants or pathogens like antibiotic-resistant bacteria, etc., as well as human infectious
disease pathogens (described in Figure 2).
After COVID-19, in addition to the new monitoring of SARS-CoV-2, monkeypox and influenza RSV have recently become emergencies of international concern, and such pathogens have also become the focus of WWS, especially when most people cannot receive RSV clinical test, wastewater data can fill the gaps.
Meanwhile, the progress in wastewater genome
monitoring technology has solved the problem of multiple virus strains in wastewater.
As shown in Figure 3, according to the WHO classification of coronavirus
variant strains, new variants can be found in wastewater samples 14 days in
advance, and clinical monitoring can be determined instances of virus
transmission that cannot be captured, for high-risk groups such as student
dormitories, airports, hospitals, nursing homes and other long-term care
facilities. In addition to providing early warnings, it can also help contain
and mitigate virus outbreaks. In the long run, WWS is more an important tool
for tracking the dynamics of viral lineages in combination with dominance.
Further analysis
from the perspective of wastewater epidemiology (WBE), in resource-rich
countries is mainly assessed in sewers and sewage systems, but in resource-poor
environments, most residents are not connected to centralized wastewater treatment
plants, using pit toilets, septic or open defecation, so the WWS process varies
depending on the wastewater system.
Overall, as shown
in Figure 4, WBE includes the process of sampling, sampling methods, virus concentration and
concentration techniques, use of control viruses in the control process, virus
isolation, RNA extraction, virus detection and quantitative sequencing, and
finally completes epidemiological modeling to analyze epidemic trends.
However, WBE still faces many challenges, such as sampling control: daily changes in water flow, differences in wastewater systems, weather factors, temperature, sedimentation rate, and virus shedding and other factors. In terms of virus recovery and concentration: concentration method efficiency, RNA extraction, purification efficiency and storage of RNA, etc. Plus virus detection and/or quantification. Challenges such as RNA quality, RNA quantity, PCR inhibitors, and normalization of data will all affect COVID-19 wastewater surveillance, which faces shortcomings such as low recovery rate and long processing time.
| |
WWS is intended to complement, not
replace clinical tests
SARS-CoV-2
wastewater surveillance differs from clinical diagnostic testing in the design
and interpretation of community-scale sampling programs, as well as in the different
assays which attempted to concentrate and extract RNA from wastewater and
environmental water samples.
Because viral RNA
can be discharged into wastewater before symptoms and diagnostic testing, SARS-CoV-2 wastewater surveillance can help document trends in
high-prevalence cases of COVID-19, and in cases of low prevalence or lack of
clinical testing evidence.
Early warning can
be provided, while wastewater viral load can be used to monitor the impact of
public health social measures, including increased or relaxed restrictions, as
well as enhanced risk communication, warning the community about the
(re)emergence of the virus, and advising the community about testing,
quarantine, isolation, as well as suggest actions such as vaccinations and seeking health care.
In sum, WWS advantages include providing objective metrics that are less susceptible to biases inherent in clinical testings, such as
- health-seeking behaviour,
- disease severity (including symptomatic and asymptomatic),
- healthcare and testing accessibility,
- physician and individual response to testing propensity,
- cost and reporting constraints, etc.
We take the
interactive COVID-19 WWS of the New Zealand Institute
of Environmental Research and Science as an example (Figure 5). This dashboard
has been launched in July 2022 to allow the public to track the footprints of
SARS-CoV-2 and view national and regional epidemics, etc. latest trends.
It provides a spatial-temporal visual map; it presents wastewater statistics and provides functions such as regional options, search, and comparison of trends in different periods.
- From Figure 5(a), we can observe that Wellington shows that the wastewater data and the corresponding spikes of confirmed cases are different in three time periods (green dotted circles): during the peak period of the epidemic, due to sufficient clinical testing, the confirmed cases and wastewater data are about the same.
- In the low epidemic period, the peak of wastewater data far exceeds the confirmed status due to factors such as people feeling tired (or thinking it is unnecessary) to rub their noses, the overall detection capacity slows down, or the willingness to report decreases.
- The public can also check the latest SARS-CoV-2 variant
virus. Figure 5 (b) and (c) show the ratio and trend information respectively.
In general, the
wastewater data not only supplements clinical monitoring, but also provides
background information on the public’s epidemic prevention environment base.
The dashboard shows that wastewater data covers 73% of the population in New
Zealand. A small sample of less than one gram only needs a few expensive PCRs.
Compared with the costs of tests and costs for clinical PCR, yes, using WWS to listen to the muttering sounds from all directions in the wastewater is cheaper and wider. Plus, virus and bacteria of various kinds can be identified, warned and tracked broadly. It can also assist the public in preventing and managing risks by them selves, easily in their daily life and sustainably for the whole country health.
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| Figure 5:SARS-CoV-2 wastewater monitoring network of the Institute of Environmental Science and Research (ESR) in New Zealand COVID-19 Wastewater Surveillance Dashboard: https://esr-cri.shinyapps.io/wastewater |
Reference
[1] Nelson, Bryn. What poo tells us: wastewater surveillance comes of age amid covid, monkeypox, and polio. BMJ 378 (2022).
[2] COVIDPoops19: https://ucmerced.maps.arcgis.com/apps/dashboards/c778145ea5bb4daeb58d31afee389082
[3] Kilaru P, Hill D, Anderson K, Collins MB, Green H, Kmush BL, Larsen DA. Wastewater Surveillance for Infectious Disease: A Systematic Review. Am J Epidemiol. (2022) Oct 13.
[4] Larsen, David A., et al. Wastewater monitoring, surveillance and epidemiology: a review of terminology for a common understanding. FEMS microbes 2 (2022). 2021-08-19
[5] Gonçalves, José, et al. Centralized and decentralized wastewater-based epidemiology to infer COVID-19 transmission–A brief review. One Health (2022): 100405.
[6] World Health Organization. Environmental surveillance for SARS-COV-2 to complement public health surveillance: interim guidance, 14 April 2022. No. WHO/HEP/ECH/WSH/2022.1. WHO (2022).
[7] [3]
[8] Carducci, Annalaura, et al. Making waves: coronavirus detection, presence and persistence in the water environment: state of the art and knowledge needs for public health. Water Research 179 (2020): 115907.
[9] McPhillips, D and Howard,J (CNN), The RSV surge didnt come out of nowhere, but gaps in data made it tougher to predict, October 27, 2022. https://edition.cnn.com/2022/10/27/health/virus-surveillance-data-gaps/index.html
[10] Karthikeyan, Smruthi, et al. Wastewater sequencing reveals early cryptic SARS-CoV-2 variant transmission. Nature 609.7925 (2022): 101-108.
[11] Aguiar-Oliveira, Maria de Lourdes, et al. Wastewater-based epidemiology (WBE) and viral detection in polluted surface water: A valuable tool for COVID-19 surveillance—A brief review. International journal of environmental research and public health 17.24 (2020): 9251.
[12] [6]
medium URI: https://medium.com/@andreahuang2019/whispers-of-viruses-and-bacteria-in-wastewater-95a7776a31b3
