Standards to support an enduring capability in wastewater surveillance for public health: Where are we?

Servetas, Stephanie L.; Parratt, Kirsten H.; Brinkman, Nichole E.; Shanks, Orin C.; Smith, Ted; Mattson, Philip; Lin, Nancy J.

doi:10.1016/j.cscee.2022.100247

Cited by 11 publications

(6 citation statements)

References 30 publications

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“…In the case of wastewater surveillance data during the COVID-19 pandemic, the rapid development of scientific communication approaches via online data dashboards has been conducted in the absence of a unified organizing body, despite efforts to convene the field to address this issue. For instance, the National Institute of Standards and Technology (NIST) and the Department of Homeland Security, Science and Technology Directorate (DHS S&T) co-hosted a workshop on standards for wastewater surveillance (SWWS) ( Lin et al 2022 ; Servetas et al 2022 ). Their findings highlighted the need for standards to support the entire workflow of wastewater surveillance from sampling to the use of data, including communication.…”

Section: Introductionmentioning

confidence: 99%

Online dashboards for SARS-CoV-2 wastewater data need standard best practices: An environmental health communication agenda

Naughton

Holm

Lin

et al. 2023

Journal of Water and Health

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The COVID-19 pandemic has highlighted the benefits of wastewater surveillance to supplement clinical data. Numerous online information dashboards have been rapidly, and typically independently, developed to communicate environmental surveillance data to public health officials and the public. In this study, we review dashboards presenting SARS-CoV-2 wastewater data and propose a path toward harmonization and improved risk communication. A list of 127 dashboards representing 27 countries was compiled. The variability was high and encompassed aspects including the graphics used for data presentation (e.g., line/bar graphs, maps, and tables), log versus linear scale, and 96 separate ways of labeling SARS-CoV-2 wastewater concentrations. Globally, dashboard presentations also differed by region. Approximately half of the dashboards presented clinical case data, and 25% presented variant monitoring. Only 30% of dashboards provided downloadable source data. While any single dashboard is likely useful in its own context and locality, the high variation across dashboards at best prevents optimal use of wastewater surveillance data on a broader geographical scale and at worst could lead to risk communication issues and the potential for public health miscommunication. There is a great opportunity to improve scientific communication through the adoption of uniform data presentation conventions, standards, and best practices in this field.

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Section: Introductionmentioning

confidence: 99%

Online dashboards for SARS-CoV-2 wastewater data need standard best practices: An environmental health communication agenda

Naughton

Holm

Lin

et al. 2023

Journal of Water and Health

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“…For example, environmental monitoring for viral threats via wastewater surveillance is a key component of pandemic threat early-warning systems prioritized in the Biden Administration's "American Pandemic Preparedness: Transforming our Capabilities" plan [15]. In addition, the Under Secretary of Defense for Health" to identify challenges and solutions for maturing an ensuring WWS capability for detecting and monitoring public health threats [19,20].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, CDC is applying WWS within passenger airplanes as part of its Traveler Genomic Surveillance program [18]. Finally, in June 2021, the National Institute of Standards and Technology (NIST) and the Department of Homeland Security (DHS), Science and Technology Directorate convened a virtual workshop, entitled “Standards to Support an Enduring Capability in Wastewater Surveillance for Public Health” to identify challenges and solutions for maturing an ensuring WWS capability for detecting and monitoring public health threats [19,20].…”

Section: Introductionmentioning

confidence: 99%

Wastewater surveillance pilot at US military installations: a cost model analysis

Sanjak,

McAuley,

Pinkham

et al. 2023

Preprint

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BackgroundThe coronavirus disease 2019 (COVID-19) pandemic highlighted the need for pathogen surveillance systems to augment both early warning and outbreak monitoring/control efforts. Wastewater samples provide a rapid and accurate source of environmental surveillance data to complement direct patient sampling. Due to its global presence and critical missions, the US military is a leader in global pandemic preparedness efforts. Clinical testing for COVID-19 on US Air Force (USAF) bases (AFBs) was effective, but costly with respect to direct costs and indirect costs of lost time. To remain operating at peak capacity such bases sought a more passive surveillance option and piloted wastewater surveillance (WWS) at 17 AFBs to demonstrate feasibility, safety, and utility from May 2021 to January 2022.ObjectiveHere we model the costs of a wastewater program for pathogens of pandemic potential within the specific context of US military installations using assumptions based on the results of the USAF and Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense (JPEO-CBRND) pilot program. The objective was to determine the cost of deploying WWS to all AFBs, relative to clinical swab testing surveillance regimes.MethodsA simple WWS cost projection model was built based on subject matter expert input and actual costs incurred during a WWS pilot program at USAF AFBs. Several SARS-CoV-2 circulation scenarios were considered and costs of both WWS and clinical swab testing were projected. Break even analysis was conducted to determine how reduction in swab testing could open up space to enable WWS to occur in complement.ResultsOur model confirms that wastewater surveillance is complementary and highly cost-effective when compared to existing alternative forms of biosurveillance. We find that the cost of WWS was between $10.5 - $18.5 million less expensive annually in direct costs as compared to clinical swab testing surveillance. When indirect cost of lost work is incorporated, including assumed lost work required to go obtain a clinical swab test, we estimate that over two thirds of clinical swab testing could be maintained with no additional costs upon implementation of WWS.ConclusionsOur results support adoption of wastewater surveillance across US military installations as part of a more comprehensive and early warning system that will enable adaptive monitoring during disease outbreaks.

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“…More than 4500 sites globally have analysed samples for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in wastewater since the start of the coronavirus disease 2019 (COVID-19) pandemic,1 thereby providing data that complement clinical data relevant to the pandemic. Laboratory standards for SARS-CoV-2 wastewater surveillance have largely focused on sewered systems with supporting PCR-based analyses 2. Additional surveillance efforts are increasingly moving beyond SARS-CoV-2 to other public health diseases of concern, such as influenza and polio, which can also be detected in wastewater 3 4.…”

Section: Introductionmentioning

confidence: 99%

“…Laboratory standards for SARS-CoV-2 wastewater surveillance have largely focused on sewered systems with supporting PCR-based analyses. 2 Additional surveillance efforts are increasingly moving beyond SARS-CoV-2 to other public health diseases of concern, such as influenza and polio, which can also be detected in wastewater. 3 4 Long-term and ongoing WHO environmental surveillance efforts for poliovirus were established before the recent pandemic 5 ; in this respect, detection is not necessarily a target for expansion, but rather provides a model for replication.…”

Section: Introductionmentioning

confidence: 99%

Addressing the challenges of establishing quality wastewater or non-sewered sanitation-based surveillance, including laboratory and epidemiological considerations, in Malawi

Holm,

Nyirenda,

Smith

et al. 2023

BMJ Glob Health

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Learning from clinical laboratories, wastewater or environmental (including non-sewered sanitation) environmental microbiology laboratories can be established in resource-limited settings that focus on pathogen detection and pandemic prevention. Transparent discussions on the laboratory challenges and adaptations required for this can help meet the future requirements of health research and surveillance. This report aims to describe the challenges encountered when setting up a wastewater or environmental laboratory for multipathogen surveillance in Malawi, a resource-limited setting, as well as the lessons learnt. We identified nine unifying themes: what to monitor, human resource capacity, indicators of data quality, equipment availability, supply of consumable goods, ongoing operation and maintenance of the laboratory, application of localised guidelines for laboratory operations, lack of real-time clinical correlation for calibration and localised ethical considerations. Over our 6-month timeline, onlySalmonellatyphi,Vibrio choleraeand severe acute respiratory syndrome coronavirus 2 analyses were set-up. However, we were unable to set-up measles and tuberculosis analyses owing largely to supply delays. By establishing this system at a public higher education academic laboratory in Malawi, we have ensured that ongoing capacity building and piloting of public health work is conducted in the country, rather than relying on non-governmental organisations or reference laboratory support beyond national borders. This work is not intended to replace clinical testing but rather demonstrates the potential for adapting higher education academic laboratory infrastructure to add wastewater or environmental (including non-sewered sanitation) samples, where appropriate, as additive epidemiological data for better pandemic preparedness.

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Standards to support an enduring capability in wastewater surveillance for public health: Where are we?

Cited by 11 publications

References 30 publications

Online dashboards for SARS-CoV-2 wastewater data need standard best practices: An environmental health communication agenda

Online dashboards for SARS-CoV-2 wastewater data need standard best practices: An environmental health communication agenda

Wastewater surveillance pilot at US military installations: a cost model analysis

Addressing the challenges of establishing quality wastewater or non-sewered sanitation-based surveillance, including laboratory and epidemiological considerations, in Malawi

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