ABSTRACT
As of 8 July 2022, the World Health Organization (WHO) have reported 1010 probable cases of acute hepatitis of unknown aetiology in children worldwide, including approximately 250 cases in the United Kingdom (UK). Clinical presentations have often been severe, with liver transplantation a frequent clinical outcome. Human adenovirus F41 (HAdV-F41) has been detected in most children with acute hepatitis, but its role in the pathogenesis of this infection has yet to be established. Wastewater-based epidemiology (WBE) has become a well-established tool for monitoring the community spread of SARS-CoV-2, as well as other pathogens and chemicals. In this study, we adopted a WBE approach to monitoring levels of HAdV-F40/41 in wastewater before and during an acute hepatitis outbreak in Northern Ireland. We report increasing detection of HAdV-F40/41 in wastewater, concomitant with increasing numbers of clinical cases. Amplicon whole genome sequencing further classified the wastewater-derived HAdV as belonging to the F41 genotype which in turn was homologous to clinically derived sequences. We propose that WBE has the potential to inform community surveillance of HAdV-F41 and can further contribute to the ongoing global discussion supporting HAdV-F41 involvement in acute hepatitis cases. © 2022 The Authors
ABSTRACT
Wastewater-based epidemiology (WBE) has the capacity to provide effective surveillance of entire communities by determining levels of health-associated biomarkers, viruses, and bacteria. WBE has been used globally as a key metric in determining prevalence of SARS-CoV-2 in the community. However, the application of WBE for the surveillance of other respiratory viruses has been poorly studied. Respiratory syncytial virus (RSV) is a seasonal outbreak disease that can cause severe infections in infants, immunocompromised or elderly individuals. Currently, the administration of RSV immunoprophylaxis products for high-risk patients relies on pre-emptively determining when an outbreak of RSV may occur in the community. However, in 2021 unexpected seasonal RSV outbreaks were reported which were likely due to the relaxation of Covid-19 regulations (social distancing, face coverings etc.) posing challenges over when to initiate the supply of immunoprophylaxis. The aims of this study were to monitor the circulation of RSV in wastewater (WW), investigate if increasing detection of RSV in WW precedes the onset of clinical cases and determine the molecular epidemiology of RSV A and B genotypes. Untreated WW samples from 20 WW inlet treatment sites across Northern Ireland (NI) were collected between August 2021 and July 2022 and concentrated. Viral nucleic acid was amplified and quantified using an RSV specific RT-qPCR assay. The gene copies/L were normalised based on the rainfall flow rate and population size and then compared to the clinical case rate. For a selection of WW sites, the glycoprotein G gene was sequenced, and phylogenetic analysis was carried out. RSV concentration in wastewater mirrored the rise in clinical cases, with WW surveillance leading clinical diagnostic testing by ~1 week. WW surveillance is a valuable tool to detect and monitor outbreaks of circulating and clinically relevant respiratory viruses. Therefore, WBE has the potential to establish guidelines for diagnostic testing and preventative measures and to assist with clinical resource planning.
ABSTRACT
As of 8 July 2022, the World Health Organization (WHO) have reported 1010 probable cases of acute hepatitis of unknown aetiology in children worldwide, including approximately 250 cases in the United Kingdom (UK). Clinical presentations have often been severe, with liver transplantation a frequent clinical outcome. Human adenovirus F41 (HAdV-F41) has been detected in most children with acute hepatitis, but its role in the pathogenesis of this infection has yet to be established. Wastewater-based epidemiology (WBE) has become a well-established tool for monitoring the community spread of SARS-CoV-2, as well as other pathogens and chemicals. In this study, we adopted a WBE approach to monitoring levels of HAdV-F40/41 in wastewater before and during an acute hepatitis outbreak in Northern Ireland. We report increasing detection of HAdV-F40/41 in wastewater, concomitant with increasing numbers of clinical cases. Amplicon whole genome sequencing further classified the wastewater-derived HAdV as belonging to the F41 genotype which in turn was homologous to clinically derived sequences. We propose that WBE has the potential to inform community surveillance of HAdV-F41 and can further contribute to the ongoing global discussion supporting HAdV-F41 involvement in acute hepatitis cases.
ABSTRACT
BACKGROUND: The COVID-19 pandemic caused by SARS-CoV-2 remains a significant issue for global health, economics and society. A wealth of data has been generated since its emergence in December 2019, and it is vital for clinicians to keep up with this data from across the world at a time of uncertainty and constantly evolving guidelines and clinical practice. OBJECTIVES: Here we provide an update for clinicians on the recent developments in the virology, diagnostics, clinical presentation, viral shedding, and treatment options for COVID-19 based on current literature. SOURCES: We considered published peer-reviewed papers and non-peer-reviewed pre-print manuscripts on COVID19 and related aspects with an emphasis on clinical management aspects. CONTENT: We describe the virological characteristics of SARS-CoV-2 and the clinical course of COVID-19 with an emphasis on diagnostic challenges, duration of viral shedding, severity markers and current treatment options. IMPLICATIONS: The key challenge in managing COVID-19 remains patient density. However, accurate diagnosis as well as early identification and management of high-risk severe cases are important for many clinicians. For improved management of cases, there is a need to understand test probability of serology, qRT-PCR and radiological testing, and the efficacy of available treatment options that could be used in severe cases with a high risk of mortality.