Early warning COVID-19 outbreak in long-term care facilities using wastewater surveillance: correlation, prediction, and interaction with clinical and serological statuses

IF 20.9 1区生物学 Q1 INFECTIOUS DISEASES

Lancet Microbe Pub Date : 2024-10-01 DOI:10.1016/S2666-5247(24)00126-5

Xiaoli Pang PhD , Bonita E Lee MD , Tiejun Gao PhD , Rhonda J Rosychuk PhD , Linnet Immaraj PhD , Judy Y Qiu PhD , Jiabi Wen MS , Nathan Zelyas MD , Krista Howden DACVPM , Janelle Wallace MPh , Eleanor Risling MD , Lorie A Little MD , John Kim PhD , Heidi Wood PhD , Alyssia Robinson BA , Michael Parkins MD , Casey R J Hubert PhD , Kevin Frankowski MS , Steve E Hrudey Dsc [Eng] , Christopher Sikora MD

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引用次数: 0

Abstract

Background

The unprecedented COVID-19 pandemic has highlighted the strategic value of wastewater-based surveillance (WBS) of SARS-CoV-2. This multisite 28-month-long study focused on WBS for older residents in 12 long-term care facilities (LTCFs) in Edmonton (AB, Canada) by assessing relationships between COVID-19, WBS, and serostatus during the pandemic.

Methods

Wastewater samples collected two to three times per week were tested for SARS-CoV-2 using RT-quantitative PCR. The serostatus of antibodies was examined using immunoassays. The data of clinical COVID-19 outbreaks based on extensive testing were obtained from local public health officials. Analyses included calculating correlations between 7-day rolling averages for WBS and COVID-19 cases and investigating whether WBS led or lagged confirmed outbreaks using a multinomial test.

Findings

Wastewater results correlated well with clinical COVID-19 infections and outbreaks at participating LTCFs. 1058 (36·0%) of 2936 collected wastewater samples were SARS-CoV-2 positive, compared with 1247 people (resident n=671, staff n=572, and unknown n=4) reporting positive test results of 21 673 clinical samples assessed (5·8%). WBS led clinical testing in 32 (60·4%) confirmed outbreaks, which was significantly different from WBS lagged (12 outbreaks [22·6%, 95% CI 11·3–33·7]). Non-detection of WBS SARS-CoV-2 served as a negative predictor for outbreaks. WBS results attested protective immunity in vaccinated individuals before the omicron wave. A parallel increase in the proportions of positive WBS SARS-CoV-2 and anti-nucleocapsid antibodies underlined that omicron was an immunity-evading variant despite high seropositivity of neutralising antibodies after multiple doses of vaccine.

Interpretation

Implementation of WBS could enable targeted clinical investigations and improve cost-effectiveness of COVID-19 outbreak management in LTCFs. WBS and serostatus provided informed dynamic changes of infections and immunity. Critical evidence was that LTCF WBS is an effective early warning system to support rapid public health outbreak management and protect vulnerable older populations.

Funding

Canadian Immunity Task Force for COVID-19 and Alberta Health.

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利用废水监测预警长期护理机构中 COVID-19 的爆发：相关性、预测以及与临床和血清学状态的相互作用。

背景：史无前例的 COVID-19 大流行凸显了基于废水的 SARS-CoV-2 监测 (WBS) 的战略价值。这项为期 28 个月的多地点研究重点关注埃德蒙顿（加拿大 AB 省）12 家长期护理设施（LTCF）中老年居民的 WBS，评估 COVID-19、WBS 和大流行期间血清状态之间的关系：方法：每周收集两到三次废水样本，使用 RT 定量 PCR 对其进行 SARS-CoV-2 检测。使用免疫测定法检测抗体的血清状态。从当地公共卫生官员处获得了基于广泛检测的 COVID-19 临床爆发数据。分析包括计算 WBS 和 COVID-19 病例的 7 天滚动平均值之间的相关性，并使用多项式检验法调查 WBS 是否导致或滞后于确诊疫情：研究结果：废水处理结果与参与研究的 LTCF 的 COVID-19 临床感染和疫情有很好的相关性。在收集的 2936 份废水样本中，有 1058 份（36-0%）SARS-CoV-2 呈阳性，而在评估的 21 673 份临床样本中，有 1247 人（住院病人 671 人，员工 572 人，未知人数 4 人）的检测结果呈阳性（5-8%）。在 32 起（60-4%）确诊疫情中，WBS 主导了临床检测，这与 WBS 滞后（12 起疫情 [22-6%, 95% CI 11-33-7]）有显著不同。未检测到 WBS SARS-CoV-2 是疫情爆发的负面预测因素。WBS 结果证明，在 Omicron 疫潮之前，接种过疫苗的人具有保护性免疫力。WBS SARS-CoV-2 阳性和抗核头壳抗体阳性比例的平行增加突出表明，尽管接种多剂疫苗后中和抗体的血清阳性率很高，但奥米克浪是一种免疫消减变体：解读：实施WBS可以进行有针对性的临床调查，并提高COVID-19在LTCF疫情管理中的成本效益。WBS和血清状态为感染和免疫的动态变化提供了信息。关键证据表明，LTCF WBS 是一种有效的早期预警系统，可支持快速公共卫生疫情管理并保护弱势老年人群：资金来源：COVID-19 加拿大免疫工作组和阿尔伯塔省卫生部。

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来源期刊

Lancet Microbe Multiple-

CiteScore

27.20

自引率

0.80%

发文量

278

审稿时长

6 weeks

期刊介绍： The Lancet Microbe is a gold open access journal committed to publishing content relevant to clinical microbiologists worldwide, with a focus on studies that advance clinical understanding, challenge the status quo, and advocate change in health policy.