Building-level wastewater surveillance as an early warning system for COVID-19 outbreaks in congregate living settings†

IF 3.5 4区 环境科学与生态学 Q3 ENGINEERING, ENVIRONMENTAL
Natalie G. Exum, Steven J. Chow, Caroline Coulter, Christopher D. Gocke, Andrew Pekosz, Roanna Kessler and Kellogg J. Schwab
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Abstract

The COVID-19 pandemic presented an opportunity to collect wastewater (WW) from a defined population of individuals within a building and monitor the sewage for viral RNA as a leading indicator of COVID-19 infections. The evaluation of the effectiveness of building-level WW surveillance programs as an early warning system has been limited by a lack of frequent asymptomatic surveillance of the defined residential population under WW surveillance. In this study we present the epidemiologic diagnostics of WW surveillance (sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV)) from university residence halls. WW surveillance was layered on top of a rigorous asymptomatic testing program (three times per week) and serves as the gold standard for comparison. This study also spanned across both the Spring 2021 semester when students were unvaccinated and the Fall 2021 semester when >95% of students were vaccinated for COVID-19 to understand how increased immunity may affect viral detection in WW. We analyzed composite WW samples from nine residential buildings that were collected twice weekly. The overall positive WW sample detection rate was 5.5% indicating the low-incidence context of this study population to allow for evaluation of WW surveillance as an early warning system. WW surveillance showed the best performance as a leading indicator of an infected individual when compared in a time inclusive of 1–2 days prior to the date of a clinical positive. The building-level WW surveillance sensitivity and specificity was found to be 60% and 94.9% (PPV: 47.4%; NPV: 96.9%), respectively in the Spring 2021; in the Fall 2021 sensitivity was reduced to 6.3% and specificity remained at a similar level of 97.5% (PPV: 14.3%; NPV: 94.1%). Combined for both semesters, the overall sensitivity and specificity were 32.3% and 96.4% (PPV: 38.5%; NPV: 95.3%). Convalescent shedding may explain up to 31% of false positive WW samples, contributing to decreased surveillance performance. This study demonstrates the greater effectiveness of building-level WW surveillance as an early warning system at the beginning of the COVID-19 pandemic when population-level immunity was naïve and fecal shedding of SARS-CoV-2 was likely more prevalent.

Abstract Image

建筑级废水监测作为聚集生活环境中COVID-19疫情的预警系统
2019冠状病毒病大流行为收集建筑物内特定人群的废水(WW)并监测污水中的病毒RNA作为2019冠状病毒病感染的主要指标提供了机会。由于缺乏对WW监测下定义的居住人口的频繁无症状监测,对建筑物级WW监测计划作为预警系统的有效性评估受到限制。在这项研究中,我们介绍了大学宿舍WW监测的流行病学诊断(敏感性(Se),特异性(Sp),阳性预测值(PPV)和阴性预测值(NPV))。WW监测是在严格的无症状检测程序(每周三次)之上分层进行的,并作为比较的金标准。这项研究还跨越了2021年春季学期,当时学生没有接种疫苗,以及2021年秋季学期,95%的学生接种了COVID-19疫苗,以了解免疫力的提高如何影响世界各地的病毒检测。我们分析了来自9个住宅建筑的复合WW样本,这些样本每周收集两次。总体WW阳性样本检出率为5.5%,表明本研究人群的低发病率背景允许将WW监测作为早期预警系统进行评估。在包括临床阳性日期前1-2天的时间内,WW监测作为感染个体的主要指标表现最佳。建筑物层面WW监测的敏感性和特异性分别为60%和94.9% (PPV: 47.4%;NPV: 96.9%),分别为2021年春季;在2021年秋季,敏感性降至6.3%,特异性保持在97.5%的相似水平(PPV: 14.3%;净现值:94.1%)。两学期合并后,总体敏感性和特异性分别为32.3%和96.4% (PPV: 38.5%;净现值:95.3%)。恢复期脱落可解释高达31%的WW假阳性样本,导致监测性能下降。该研究表明,在COVID-19大流行开始时,建筑级WW监测作为早期预警系统具有更大的有效性,当时人群水平的免疫力为naïve,并且SARS-CoV-2的粪便脱落可能更为普遍。
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来源期刊
Environmental Science: Water Research & Technology
Environmental Science: Water Research & Technology ENGINEERING, ENVIRONMENTALENVIRONMENTAL SC-ENVIRONMENTAL SCIENCES
CiteScore
8.60
自引率
4.00%
发文量
206
期刊介绍: Environmental Science: Water Research & Technology seeks to showcase high quality research about fundamental science, innovative technologies, and management practices that promote sustainable water.
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