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medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.06.06.22275866


Wastewater-based epidemiology (WBE) has been extensively used during the COVID-19 pandemic to detect and monitor the spread of the SARS-CoV-2 virus and its variants. It has also proven to be an excellent tool to complement and support insights gained from reported clinical data. Globally, many groups have developed bioinformatics pipelines to analyse sequencing data from wastewater. Accurate calling of mutations from RNA extracted from wastewater samples is key in supporting clinical data to make informed decisions on the prevalence of variants, as well as in the use of WBE as a molecular surveillance tool. However, wastewater samples can be challenging to extract and sequence, and performance of variant-calling algorithms in this context has, so far, not been investigated. Analysis of the data and assignment of circulating variants depends heavily on the accuracy of the variant caller, particularly given the degraded nature of the viral RNA and the heterogeneous nature of metagenomic samples. To address this, we compared the performance of six variant callers (VarScan, iVAR, GATK, FreeBayes, LoFreq and BCFtools), used widely in bioinformatics pipelines, on 19 synthetic samples with a known mix of three different SARS-CoV-2 variant genomes (Alpha, Beta and Delta), as well as 13 wastewater samples collected in London between the 15 th and 18 th December 2021. Using the Quasimodo benchmarking tool to compare the six variant callers, we assessed the fundamental parameters of recall (sensitivity) and precision (specificity) in confirming the presence of a variant within the population. Our results show that BCFtools, FreeBayes and VarScan called the expected mutations with higher precision and recall than iVAR or GATK, although the latter identified more expected defining mutations. LoFreq gave the least reliable results due to the high number of false positive mutations detected, resulting in lower precision. Similar results were obtained for both the synthetic and wastewater samples.

medrxiv; 2021.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2021.08.03.21261365


This paper aims to determine whether population normalisation significantly alters the SARS-CoV-2 trends revealed by wastewater-based epidemiology, and whether it is beneficial and/or necessary to provide an understanding of prevalence from wastewater SARS-CoV-2 concentrations. It uses wastewater SARS-CoV-2 data collected from 394 sampling sites, and implements normalisation based on concentrations of a) ammoniacal nitrogen, and b) orthophosphate. Wastewater SARS-CoV-2 metrics are evaluated at a site and aggregated level against three indicators prevalence, based on positivity rates from the Office for National Statistics Coronavirus Infection Survey and test results reported by NHS Test and Trace. Normalisation is shown to have little impact on the overall trends in the wastewater SARS-CoV-2 data on average. However, significant variability between the impact of population normalisation at different sites, which is not evident from previous WBE studies focussed on a single site, is also revealed. Critically, it is demonstrated that while the impact of normalisation on SARS-CoV-2 trends is small on average, it is not reasonable to conclude that it is always insignificant. When averaged across many sites, normalisation strengthens the correlation between wastewater SARS-CoV-2 data and indicators of prevalence; however, confidence in the improvement is low. Lastly, it is noted that most data were collected during periods of national lockdown and/or local restrictions, and thus the impacts and benefits of population normalisation are expected to be higher when normal travel habits resume.

medrxiv; 2021.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2021.08.03.21261377


Wastewater surveillance has been widely implemented for monitoring of SARS-CoV-2 during the global COVID-19 pandemic, and near-to-source monitoring is of particular interest for outbreak management in discrete populations. However, variation in population size poses a challenge to the triggering of public health interventions using wastewater SARS-CoV-2 concentrations. This is especially important for near-to-source sites that are subject to significant daily variability in upstream populations. Focusing on a university campus in England, this study investigates methods to account for variation in upstream populations at a site with highly transient footfall and provides a better understanding of the impact of variable populations on the SARS-CoV-2 trends provided by wastewater-based epidemiology. The potential for complementary data to help direct response activities within the near-to-source population is also explored, and potential concerns arising due to the presence of heavily diluted samples during wet weather are addressed. Using wastewater biomarkers, it is demonstrated that population normalisation can reveal significant differences between days where SARS-CoV-2 concentrations are very similar. Confidence in the trends identified is strongest when samples are collected during dry weather periods; however, wet weather samples can still provide valuable information. It is also shown that building-level occupancy estimates based on complementary data aid identification of potential sources of SARS-CoV-2 and can enable targeted actions to be taken to identify and manage potential sources of pathogen transmission in localised communities.