The utility of wastewater surveillance for monitoring SARS-CoV-2 prevalence
File(s)
Published version
Author(s)
Mills, Cathal
Chadeau-Hyam, Marc
Elliott, Paul
Donnelly, Christl A
Type
Journal Article
Abstract
Public health authorities have increasingly used wastewater-based epidemiology (WBE) to monitor community transmission of SARS-CoV-2 and other agents. Here, we evaluate the utility of WBE during the COVID-19 pandemic in England for estimating SARS-CoV-2 prevalence. We use wastewater data from the Environmental Monitoring for Health Protection (EMHP) programme and prevalence data from the REal-time Assessment of Community Transmission-1 (REACT-1) study. Across the pandemic, we describe how wastewater-based modelling can achieve representative SARS-CoV-2 prevalence estimates in fine and coarse spatial resolutions for relatively short time horizons (of up to one month), and thus assist in filling temporal gaps in surveillance. We infer a temporally evolving relationship between wastewater and prevalence which may limit the utility of WBE for estimating SARS-CoV-2 prevalence over longer time horizons without a concurrent prevalence survey. Exploring further our finding of time-varying, population-level faecal shedding, we characterise WBE for SARS-CoV-2 prevalence as i) vaccination-coverage-dependent and ii) variant-specific. Our research suggests that these factors are important considerations in future uses of WBE by public health authorities in infectious disease outbreaks. We further demonstrate that WBE can improve both the cost efficiency and accuracy of community prevalence surveys which on their own may have incomplete geographic coverage and/or small sample sizes. Therefore, in England, for the objective of high spatial resolution prevalence monitoring, strategic use of SARS-CoV-2 wastewater concentration data nationally could have enhanced, but not replaced, community prevalence survey programmes.
Date Issued
2024-10
Date Acceptance
2024-09-06
Citation
PNAS Nexus, 2024, 3 (10)
ISSN
2752-6542
Publisher
Oxford University Press
Journal / Book Title
PNAS Nexus
Volume
3
Issue
10
Copyright Statement
© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences. This is an
Open Access article distributed under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction
in any medium, provided the original work is properly cited.
Open Access article distributed under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction
in any medium, provided the original work is properly cited.
License URL
Identifier
http://dx.doi.org/10.1093/pnasnexus/pgae438
Publication Status
Published
Article Number
pgae438
Date Publish Online
2024-10-04