Wastewater surveillance for infectious disease: a systematic review

Abstract

Wastewater surveillance of SARS-CoV-2 has shown to be a valuable source of information regarding SARS-CoV-2 transmission and COVID-19 cases. Though the method has been used for several decades to track other infectious diseases, there has not been a comprehensive review outlining all of the pathogens surveilled through wastewater. The aim of this study is to identify what infectious diseases have been previously studied via wastewater surveillance prior to the COVID-19 Pandemic and identify common characteristics between the studies, as well as identify current gaps in knowledge. Peer-reviewed articles published as of August 1, 2020 that examined wastewater for communicable and infectious human pathogens on 2 or more occasions were included in the study. Excluded from this list were all reviews and methods papers, single collection studies, and non-human pathogens. Infectious diseases and pathogens were identified in studies of wastewater surveillance, as well as themes of how wastewater surveillance and other measures of disease transmission were linked. This review did not include any numerical data from individual studies and thus no statistical analysis was done. 1005 articles were identified but only 100 were included in this review after applying the inclusion criteria. These studies came from 38 countries with concentration in certain countries including Italy, Israel, Brazil, Japan, and China. Twenty-five separate pathogen families were identified in the included studies, with the majority of studies examining pathogens from the family Picornaviridae, including polio and non-polio enteroviruses. Most studies of wastewater surveillance did not link what was found in the wastewater to other measures of disease transmission. Among those studies that did compare wastewater surveillance to other measures of disease transmission the value observed was dependent upon pathogen and varied by study. Wastewater surveillance has historically been used to assess water-borne and fecal-orally transmitted pathogens causing diarrheal disease. However, numerous other types of pathogens have been surveilled using wastewater and wastewater surveillance should be considered as a potential tool for many infectious diseases. Wastewater surveillance studies can be improved by incorporating other measures of disease transmission at the population-level including disease incidence and hospitalizations.

Wastewater Surveillance System as a Complementary Approach for Rapid Identification of Infectious Diseases Outbreaks

“…Meanwhile, they also need to monitor multiple diseases, even rare diseases. (22,23) A systematic review revealed that the major pathogens monitored in wastewater are infections with the families Picornaviridae, Adenoviridae, Calciviridae, Hepeviridae, and Reoviridae, three of which are known to contribute to diarrheal infections, (1) as shown in Figure 2. (1) Human pathogens discharged in substantial liquids were monitored to decide the source of natural agents in the sewer and the length of agent discharge.…”

“…(22,23) A systematic review revealed that the major pathogens monitored in wastewater are infections with the families Picornaviridae, Adenoviridae, Calciviridae, Hepeviridae, and Reoviridae, three of which are known to contribute to diarrheal infections, (1) as shown in Figure 2. (1) Human pathogens discharged in substantial liquids were monitored to decide the source of natural agents in the sewer and the length of agent discharge. Diverse sources of biological agents in sewers are feces, pee, skin from the shower and hand washing, and saliva from respiratory discharges.…”

“…Even with the advancement of infectious disease surveillance over the last century, communicable diseases still pose significant risks to public health. (1,2) Surveillance is a continuous systematic collection, analysis, and interpretation of health-related data in describing and monitoring a health event. In addition to providing information that is used for planning, implementing, and evaluating public health interventions and programs.…”

Influenza transmission dynamics quantified from wastewater

“…Many pathogens are shed by infected individuals via stool, sputum, and/or from the skin, depending on the pathogen.This means pathogen particles can make it into wastewater when infected individuals use the toilet, brush their teeth, or shower. Previous studies have shown that a range of pathogens are detectable in wastewater samples (Xagoraraki and O’Brien 2020; Kilaru et al 2022). In regions where household wastewater is centrally collected, wastewater represents a pooled community sample and wastewater pathogen loads indicate community disease burden.…”

Complementing RNA Detection with Pharmaceutical Monitoring for Early Warning of Viral Outbreaks through Wastewater-Based Epidemiology

“…Wastewater-based epidemiology (WBE) has attracted attention as an emerging outbreak surveillance tool due to its advantages, including flexibility, cost-effectiveness in sample collection, near real-time data, and capacity to provide a snapshot of an entire community’s health compared to traditional surveillance systems. − Wastewater-based epidemiology is based on collecting relevant information from untreated sewage, through biological and/or chemical analyses to detect biomarkers associated with infectious diseases or environmental risk factors. , Because human excreta contain biomarkers indicative of multiple aspects of risks, raw sewage is an ideal source of information . As a result, WBE has been widely implemented for the detection of SARS-CoV-2, as well as illicit drug usage , and consumption of pharmaceuticals …”