Expanding the Pathogen Panel in Wastewater Epidemiology to Influenza and Norovirus.

Since the start of the 2019 pandemic, wastewater-based epidemiology (WBE) has proven to be a valuable tool for monitoring the prevalence of SARS-CoV-2. With methods and infrastructure being settled, it is time to expand the potential of this tool to a wider range of pathogens. We used over 500 archived RNA extracts from a WBE program for SARS-CoV-2 surveillance to monitor wastewater from 11 treatment plants for the presence of influenza and norovirus twice a week during the winter season of 2021/2022. Extracts were analyzed via digital PCR for influenza A, influenza B, norovirus GI, and norovirus GII. Resulting viral loads were normalized on the basis of NH4-N. Our results show a good applicability of ammonia-normalization to compare different wastewater treatment plants. Extracts originally prepared for SARS-CoV-2 surveillance contained sufficient genomic material to monitor influenza A, norovirus GI, and GII. Viral loads of influenza A and norovirus GII in wastewater correlated with numbers from infected inpatients. Further, SARS-CoV-2 related non-pharmaceutical interventions affected subsequent changes in viral loads of both pathogens. In conclusion, the expansion of existing WBE surveillance programs to include additional pathogens besides SARS-CoV-2 offers a valuable and cost-efficient possibility to gain public health information.

Viral variant-resolved wastewater surveillance of SARS-CoV-2 at national scale.

SARS-CoV-2 surveillance by wastewater-based epidemiology is poised to provide a complementary approach to sequencing individual cases. However, robust quantification of variants and de novo detection of emerging variants remains challenging for existing strategies. We deep sequenced 3,413 wastewater samples representing 94 municipal catchments, covering >59% of the population of Austria, from December 2020 to February 2022. Our system of variant quantification in sewage pipeline designed for robustness (termed VaQuERo) enabled us to deduce the spatiotemporal abundance of predefined variants from complex wastewater samples. These results were validated against epidemiological records of >311,000 individual cases. Furthermore, we describe elevated viral genetic diversity during the Delta variant period, provide a framework to predict emerging variants and measure the reproductive advantage of variants of concern by calculating variant-specific reproduction numbers from wastewater. Together, this study demonstrates the power of national-scale WBE to support public health and promises particular value for countries without extensive individual monitoring.

Quest for Optimal Regression Models in SARS-CoV-2 Wastewater Based Epidemiology.

Wastewater-based epidemiology is a recognised source of information for pandemic management. In this study, we investigated the correlation between a SARS-CoV-2 signal derived from wastewater sampling and COVID-19 incidence values monitored by means of individual testing programs. The dataset used in the study is composed of timelines (duration approx. five months) of both signals at four wastewater treatment plants across Austria, two of which drain large communities and the other two drain smaller communities. Eight regression models were investigated to predict the viral incidence under varying data inputs and pre-processing methods. It was found that population-based normalisation and smoothing as a pre-processing of the viral load data significantly influence the fitness of the regression models. Moreover, the time latency lag between the wastewater data and the incidence derived from the testing program was found to vary between 2 and 7 days depending on the time period and site. It was found to be necessary to take such a time lag into account by means of multivariate modelling to boost the performance of the regression. Comparing the models, no outstanding one could be identified as all investigated models are revealing a sufficient correlation for the task. The pre-processing of data and a multivariate model formulation is more important than the model structure.

Detection and Stability of SARS-CoV-2 Fragments in Wastewater: Impact of Storage Temperature.

SARS-CoV-2 wastewater epidemiology suffers from uncertainties concerning sample storage. We show the effect of the storage of wastewater on the detectable SARS-CoV-2 load. Storage at 4 °C for up to 9 days had no significant effect, while storage at -20 °C led to a significant reduction in gene copy numbers.