Implementation of environmental surveillance for SARS-CoV-2 virus to support public health decisions: opportunities and challenges

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Medema, Gertjan
Been, Frederic
Heijnen, Leo
Petterson, Susan
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2020
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https://creativecommons.org/licenses/by-nc-nd/4.0/
Abstract

Analysing wastewater can be used to track infectious disease agents that are shed via stool and urine. Sewage surveillance of SARS-CoV-2 has been suggested as tool to determine the extent of COVID-19 in cities and serve as early warning for (re-)emergence of SARS-CoV-2 circulation in communities. The focus of this review is on the strength of evidence, opportunities and challenges for the application of sewage surveillance to inform public health decision making. Considerations for undertaking sampling programs are reviewed including sampling sites, strategies, sample transport, storage and quantification methods; together with the approach and evidence base for quantifying prevalence of infection from measured wastewater concentration. Published SARS-CoV-2 sewage surveillance studies (11 peer reviewed, and 10 pre-prints) were reviewed to demonstrate the current status of implementation to support public health decisions. Whilst being very promising, a number of areas were identified requiring additional research to further strengthen this approach and take full advantage of its potential. In particular, design of adequate sampling strategies, spatial and temporal resolution of sampling, sample storage, replicate sampling and analysis, controls for the molecular methods used for quantification of SARS-CoV-2 RNA in wastewater. The use of appropriate prevalence data and methods to correlate or even translate SARS-CoV-2 concentrations in wastewater to prevalence of virus shedders in the population is discussed.

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Current Opinion in Environmental Science & Health
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© 2020 Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence (http://creativecommons.org/licenses/by-nc-nd/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.
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Subject
Health services and systems
Public health
COVID-19
SARS-CoV-2
sewage surveillance
wastewater
wastewater-based epidemiology
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Medema, G; Been, F; Heijnen, L; Petterson, S, Implementation of environmental surveillance for SARS-CoV-2 virus to support public health decisions: opportunities and challenges, Current Opinion in Environmental Science & Health, 2020
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