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Wastewater surveillance

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From Molecupedia, the encyclopedia of very small things
Measurement of pathogens, drugs and other markers in sewage to follow the health of the people who produced it
See also: Biosurveillance

Wastewater surveillance, also called wastewater-based epidemiology or sewage epidemiology, is the measurement of markers in sewage to learn about the people connected to the sewer. A treatment plant receives the excreta of everyone in its catchment, called a sewershed, mixed into one stream. A sample of that stream gives a single number for a population that may be a neighborhood or a city of millions, whether or not any of its members saw a doctor. The markers measured include poliovirus, SARS-CoV-2, influenza, residues of illicit drugs and, in some programs, more than fifty health indicators.

History

Sewage was first sampled for a virus in the 1930s, when poliovirus was recovered from it, a history told in Biosurveillance. The method became routine in the effort to eradicate polio. Infected people, whether or not they are paralyzed, shed large amounts of poliovirus in feces for weeks, and because only a small share of infections causes paralysis, environmental surveillance can under good conditions detect transmission more sensitively than counting paralyzed patients. The World Health Organization included it in its strategic plan for the Global Polio Eradication Initiative for 2010 to 2012.[1] Israel had been certified polio-free in June 2002. In 2013 wild poliovirus type 1 turned up in routine sewage samples taken from two cities in the south of the country between April 7 and 13, and the analysis put its arrival in early February.[2]

Drugs came next. In 2001 Daughton proposed sewage as a way to measure the use of illicit drugs, and in 2005 an Italian group measured cocaine and its urinary metabolite in the River Po, whose five million inhabitants sent about 4 kg of cocaine a day to the sea, a figure that implied far more use than official statistics did.[3][4] By 2008 the same group had profiled Milan, Lugano and London and had seen that cocaine use in Milan rose on weekends.[5]

COVID-19

Early reports of SARS-CoV-2 in sewage came from three continents.

Early reports of SARS-CoV-2 RNA in sewage
Place Sampling Finding
Australia One treatment plant Two positive detections within six days; a model put the number infected in the catchment at 171 to 1,090[6]
Massachusetts One urban plant, March 18 to 25, 2020 57 to 303 copies per mL of sewage, more than expected from the confirmed cases[7]
Northern Italy 40 samples from five plants, October 2019 to February 2020 15 positive; the earliest on December 18, 2019, in Milan and Turin, before the first documented Italian case of February 21, 2020[8]

The Italian group concentrated its samples by the standard World Health Organization procedure for poliovirus sewage surveillance, with modifications.[8] A method built for one virus was reused for another within months. In the United States the Centers for Disease Control and Prevention started the National Wastewater Surveillance System in September 2020, which by August 2021 covered 37 states, four cities and two territories. The agency's reasoning was that about 40% of people infected with SARS-CoV-2 shed viral RNA in stool, so sewage reflects symptomatic and asymptomatic infections alike.[9]

Two programs outside government grew alongside it. WastewaterSCAN is based at Stanford University in partnership with Emory University, with Verily as its laboratory partner; it began with eight treatment plants in November 2020 and its site now counts nearly 150.[10] Boehm and colleagues measured influenza, respiratory syncytial virus, parainfluenza, rhinovirus, metapneumovirus and seasonal coronaviruses in the solids of a California plant three times a week for 17 months, 216 samples in all, and found RNA from every virus they tested for.[11] The commercial company Biobot Analytics describes itself as "the world's first and most advanced wastewater intelligence platform" that tracks over 50 human health trends, from SARS-CoV-2 and measles to fentanyl and cocaine.[12]

Method

A laboratory takes either a composite of influent collected over 24 hours or the settled solids from the plant, concentrates the virus, extracts the nucleic acids and measures the target by reverse transcription and quantitative PCR or by digital PCR. The results are hard to compare between plants, since flow, dilution and the number of people contributing all vary. One answer is to divide by a marker of human feces. Pepper mild mottle virus, a plant virus from peppers in the diet, is the most abundant RNA virus in human feces and is excreted by a large share of healthy people.[13] Dividing SARS-CoV-2 by it, an analysis of seven plants serving about 9 million people, 3% of the United States, found that a tenfold change in the ratio went with a change of 0.24 in the base-10 logarithm of laboratory-confirmed incidence.[14]

Limits remain. A review of 2020 listed the lack of an optimized, standardized protocol among the main challenges of measuring SARS-CoV-2 in sewage.[15] Concentrations are low. The Massachusetts figures, 57 to 303 copies per mL, are about 0.1 to 0.5 attomolar,[a] some two million to ten million times less than the picomolar order that limits sensors in unmixed solution, because of how molecules get to them, as described in Biosurveillance. The laboratory does not try to see that concentration directly. It concentrates the virus first and amplifies the RNA afterward.

At Molecular Reality

Molecular Reality Corporation wants to put its sensors at the other end of the sewer. Its statement of purpose of 2022 lists "air handling systems, toilets, and drains" as the sites for them, in a program it calls Utility-scale molecular sensing, and the defensive use of the network it calls the Planetary Bioshield.[16] A sensor in a building drain would see the people in that building, where a plant in the study above averaged about 1.3 million, and the wastewater would not yet have been diluted by the rest of the city.[b] In January 2020 the company tried to build its Molecular Aquarium quickly because of COVID-19, a project that survives as a badge named CoronaPore.[17] Its field guide of August 2026 states that "nothing on the stream is a medical claim".[18]

See also

Notes

  1. ^ One copy per mL is 1,000 per liter, or 1.7 × 10−21 mol/L. At 57 copies per mL the concentration is 9.5 × 10−20 M, and at 303 copies per mL it is 5.0 × 10−19 M.
  2. ^ 9 million people divided by seven plants. The plants differed in size.

References

  1. ^ Hovi, T.; et al. (2012). "Role of environmental poliovirus surveillance in global polio eradication and beyond". Epidemiology and Infection 140 (1): 1-13. doi:10.1017/S095026881000316X.
  2. ^ Anis, E.; et al. (2013). "Insidious reintroduction of wild poliovirus into Israel, 2013". Eurosurveillance 18 (38): 20586. doi:10.2807/1560-7917.ES2013.18.38.20586.
  3. ^ Daughton, C. G. (2001). "Illicit drugs in municipal sewage". ACS Symposium Series 791: 348-364. doi:10.1021/bk-2001-0791.ch020.
  4. ^ Zuccato, E.; et al. (2005). "Cocaine in surface waters: a new evidence-based tool to monitor community drug abuse". Environmental Health 4: 14. doi:10.1186/1476-069X-4-14.
  5. ^ Zuccato, E.; et al. (2008). "Estimating community drug abuse by wastewater analysis". Environmental Health Perspectives 116 (8): 1027-1032. doi:10.1289/ehp.11022.
  6. ^ Ahmed, W.; et al. (2020). "First confirmed detection of SARS-CoV-2 in untreated wastewater in Australia: a proof of concept for the wastewater surveillance of COVID-19 in the community". Science of the Total Environment 728: 138764. doi:10.1016/j.scitotenv.2020.138764.
  7. ^ Wu, F.; et al. (2020). "SARS-CoV-2 titers in wastewater are higher than expected from clinically confirmed cases". mSystems 5 (4): e00614-20. doi:10.1128/mSystems.00614-20.
  8. ^ a b La Rosa, G.; et al. (2021). "SARS-CoV-2 has been circulating in northern Italy since December 2019: evidence from environmental monitoring". Science of the Total Environment 750: 141711. doi:10.1016/j.scitotenv.2020.141711.
  9. ^ Kirby, A. E.; et al. (2021). "Using wastewater surveillance data to support the COVID-19 response, United States, 2020 to 2021". MMWR Morbidity and Mortality Weekly Report 70 (36): 1242-1244. doi:10.15585/mmwr.mm7036a2.
  10. ^ "Our mission". WastewaterSCAN. Retrieved October 25, 2026.
  11. ^ Boehm, A. B.; et al. (2023). "Wastewater concentrations of human influenza, metapneumovirus, parainfluenza, respiratory syncytial virus, rhinovirus, and seasonal coronavirus nucleic-acids during the COVID-19 pandemic: a surveillance study". The Lancet Microbe 4 (5): e340-e348. doi:10.1016/S2666-5247(22)00386-X.
  12. ^ "Biobot Analytics". Biobot Analytics. Retrieved October 25, 2026.
  13. ^ Kitajima, M.; et al. (2018). "Pepper mild mottle virus as a water quality indicator". npj Clean Water 1: 19. doi:10.1038/s41545-018-0019-5.
  14. ^ Wolfe, M. K.; et al. (2021). "Scaling of SARS-CoV-2 RNA in settled solids from multiple wastewater treatment plants to compare incidence rates of laboratory-confirmed COVID-19 in their sewersheds". Environmental Science & Technology Letters 8 (5): 398-404. doi:10.1021/acs.estlett.1c00184.
  15. ^ Kitajima, M.; et al. (2020). "SARS-CoV-2 in wastewater: state of the knowledge and research needs". Science of the Total Environment 739: 139076. doi:10.1016/j.scitotenv.2020.139076.
  16. ^ "Our North Star: Utility-Scale Molecular Sensing". Molecular Reality Corporation. 2022.
  17. ^ "Company records". Molecular Reality Corporation. October 2026.
  18. ^ "Keltar's Field Guide to Molecular Reality". Molecular Reality Corporation. August 2026.
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