Title
Capturing the SARS-CoV-2 infection pyramid within the municipality of Rotterdam using longitudinal sewage surveillance
Author
de Graaf, Miranda (Erasmus MC; Pandemic and Disaster Preparedness Centre Rotterdam and Delft)
Langeveld, J.G. (TU Delft Sanitary Engineering; Partners4UrbanWater) 
Post, Johan (Partners4UrbanWater)
Carrizosa, Christian (Rijksinstituut voor Volksgezondheid en Milieu (RIVM); Oslo University Hospital)
Franz, Eelco (Rijksinstituut voor Volksgezondheid en Milieu (RIVM))
Izquierdo-Lara, Ray W. (Erasmus MC)
Elsinga, Goffe (KWR Water Research Institute)
Heijnen, Leo (KWR Water Research Institute)
Medema, G.J. (TU Delft Sanitary Engineering; Pandemic and Disaster Preparedness Centre Rotterdam and Delft; KWR Water Research Institute)
Date
2023
Abstract
Despite high vaccination rates in the Netherlands, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to circulate. Longitudinal sewage surveillance was implemented along with the notification of cases as two parts of the surveillance pyramid to validate the use of sewage for surveillance, as an early warning tool, and to measure the effect of interventions. Sewage samples were collected from nine neighborhoods between September 2020 and November 2021. Comparative analysis and modeling were performed to understand the correlation between wastewater and case trends. Using high resolution sampling, normalization of wastewater SARS-CoV-2 concentrations, and ‘normalization’ of reported positive tests for testing delay and intensity, the incidence of reported positive tests could be modeled based on sewage data, and trends in both surveillance systems coincided. The high collinearity implied that high levels of viral shedding around the onset of disease largely determined SARS-CoV-2 levels in wastewater, and that the observed relationship was independent of variants of concern and vaccination levels. Sewage surveillance alongside a large-scale testing effort where 58 % of a municipality was tested, indicated a five-fold difference in the number of SARS-CoV-2-positive individuals and reported cases through standard testing. Where trends in reported positive cases were biased due to testing delay and testing behavior, wastewater surveillance can objectively display SARS-CoV-2 dynamics for both small and large locations and is sensitive enough to measure small variations in the number of infected individuals within or between neighborhoods. With the transition to a post-acute phase of the pandemic, sewage surveillance can help to keep track of re-emergence, but continued validation studies are needed to assess the predictive value of sewage surveillance with new variants. Our findings and model aid in interpreting SARS-CoV-2 surveillance data for public health decision-making and show its potential as one of the pillars of future surveillance of (re)emerging viruses.
Subject
Early warning systems
Public health
SARS-COV-2
Sewage
Surveillance
To reference this document use:
http://resolver.tudelft.nl/uuid:56097a54-0844-424a-97f7-346b1bfa893f
DOI
https://doi.org/10.1016/j.scitotenv.2023.163599
Embargo date
2023-10-25
ISSN
0048-9697
Source
Science of the Total Environment, 883
Bibliographical note
Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.
Part of collection
Institutional Repository
Document type
journal article
Rights
© 2023 Miranda de Graaf, J.G. Langeveld, Johan Post, Christian Carrizosa, Eelco Franz, Ray W. Izquierdo-Lara, Goffe Elsinga, Leo Heijnen, G.J. Medema, More Authors