Wastewater Surveillance in Europe for Non-Polio Enteroviruses and Beyond

Abstract

Wastewater surveillance (WWS) was developed in the early 1960s for the detection of poliovirus (PV) circulation in the population. It has been used to monitor several pathogens, including non-polio enteroviruses (NPEVs), which are increasingly recognised as causes of morbidity in children. However, when applying WWS to a new pathogen, it is important to consider the purpose of such a study as well as the suitability of the chosen methodology. With this purpose, the European Non-Polio Enterovirus Network (ENPEN) organised an expert webinar to discuss its history, methods, and applications; its evolution from a culture-based method to molecular detection; and future implementation of next generation sequencing (NGS). The first simulation experiments with PV calculated that a 400 mL sewage sample is sufficient for the detection of viral particles if 1:10,000 people excrete poliovirus in a population of 700,000 people. If the method is applied correctly, several NPEV types are detected. Despite culture-based methods remaining the gold standard for WWS, direct methods followed by molecular-based and sequence-based assays have been developed, not only for enterovirus but for several pathogens. Along with case-based sentinel and/or syndromic surveillance, WWS for NPEV and other pathogens represents an inexpensive, flexible, anonymised, reliable, population-based tool for monitoring outbreaks and the (re)emergence of these virus types/strains within the general population.

Predicting viral gastroenteritis epidemic using sewage

“…For example, Norovirus is a well-known cause of viral gastroenteritis, which is prevalent during the winter season, while Sapovirus, Rotavirus and Astrovirus are also important (Flynn et al, 2024). Furthermore, Enteroviruses that are prevalent among children during the summer as "summer colds" cause herpangina and hand, foot and mouth disease (Bubba et al, 2023). The number of reports per sentinel is common method to check the prevalence of these viral infections.…”

Intensified Circulation of Echovirus 11 after the COVID-19 Pandemic in Poland: Detection of a Highly Pathogenic Virus Variant

“…Specifically, raw sewage contains viruses shed from both asymptomatic and symptomatic individuals. Moreover, it was proven that the pathogens detected in sewage were highly correlated with clinical cases and disease outbreaks [5,22,23].…”