Advances and implications of wastewater surveillance for SARS-CoV-2
Wastewater-based epidemiology(WBE)is a tool for monitoring the trend and spread of infectious diseases in populations.The COVID-19 pandemic has led to a surge in interest in studying WBE since it can offer a non-invasive and cost-effective way for monitoring the virus at population level.This paper discusses the principles and practices of WBE in the context of COVID-19,with a focus on its applications in Hong Kong.WBE relies on the detection of viral RNA in sewage samples,which can indicate the presence and amount of the virus in a surveyed population.The detection process involves three key steps,including sewage concentration,nucleic acid extraction,and quantitative polymerase chain reaction(qPCR)amplification of target virus sequences.Quality control measures such as positive and negative controls are crucial for generating accurate and reliable testing results.In Hong Kong,a comprehensive WBE system has been established from the ground up in 2020,which now covers 10 large sewage treatment plants,154 community surveillance sites,and multiple ad hoc sites across residential areas.The adopted sampling frequency and methods could vary according to the type of sampling site and the stage of an outbreak.Composite sewage samples are collected using automatic samplers and analyzed using standardized methods.The data generated from the WBE system is used for providing early warning and epidemiological assessment,as well as guiding public health interventions.However,the interpretation of WBE results requires careful consideration of various factors that can affect the accuracy and sensitivity of the method.These factors include the amount,frequency,and probability of viral shedding in infected individuals,variations in viral shedding over time and across different virus variants,the decay of viral particles in sewage along the sewer system and testing procedure,and the detection limit of the adopted testing method.In addition,the presence of false negative results due to randomness in sampling and fecal shedding is a significant challenge in interpretating WBE results.Therefore,it is essential to include appropriate quality control measures,use optimized sampling strategies,and validate the sewage testing data with clinical and epidemiological evidence.Despite these challenges,the experience of Hong Kong shows that WBE could provide valuable information for monitoring and responding to COVID-19 outbreaks.The WBE system in Hong Kong has been shown to be able to provide early signals of viral transmission,track the development trend of the epidemic,and locate high-risk areas for targeted public health interventions.The success of the Hong Kong WBE system highlights the importance of a comprehensive surveillance system and adaptive methods used in WBE,which requires ongoing evaluation and data analysis.WBE is a promising tool for surveying infectious diseases in populations,and its application in COVID-19 surveillance worldwide has demonstrated its great potential.However,the interpretation of WBE results requires careful considerations of various factors,such as the method's sensitivity and specificity may vary across populations and stages of an outbreak.Therefore,the establishment of a comprehensive and adaptive WBE system that integrates epidemiological,clinical,and environmental data is important for achieving the full potential of this tool in infectious disease surveillance and control.
wastewater surveillanceSARS-CoV-2public health surveillancebiological safety
邓妤、徐晓庆、郑夏婉、梁卓伟、徐浩光、李迎慧、扈庆华、杨敏、黄霞、唐宋、张岚、张彤
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香港大学土木工程系环境工程研究中心环境微生物组工程与技术实验室,香港 999077
香港大学李嘉诚医学院公共卫生学院,香港 999077
香港特别行政区政府环境保护署,香港 999077
深圳市疾病预防控制中心,深圳 518055
中国科学院生态环境研究中心,北京 100085
清华大学环境学院,北京 100084
中国疾病预防控制中心环境与健康相关产品安全所,北京 100021
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wastewater surveillance SARS-CoV-2 public health surveillance biological safety
NETL
NSTL
万方数据
维普
