scholarly journals Wastewater-based Epidemiology for Averting COVID-19 Outbreaks on The University of Arizona Campus

2020 ◽  
Author(s):  
Walter W. Betancourt ◽  
Bradley W. Schmitz ◽  
Gabriel K. Innes ◽  
Kristen M. Pogreba Brown ◽  
Sarah M. Prasek ◽  
...  
Keyword(s):  
Public Health ◽  
Disease Transmission ◽  
Population Level ◽  
Nasopharyngeal Swab ◽  
Clinical Testing ◽  
Surveillance Strategy ◽  
Public Health Action ◽  
University Of Arizona ◽  
Wastewater Samples ◽  
The University

AbstractThe University of Arizona utilized wastewater-based epidemiology paired with clinical testing as a surveillance strategy to monitor COVID-19 prevalence in a dormitory community. Positive SARS-CoV-2 RNA detection in wastewater led to prompt testing of all residents and the identification and isolation of three infected individuals which averted potential disease transmission.TextWastewater-based epidemiology (WBE) utilizes concentrations of SARS-CoV-2 in sewage to monitor population-level COVID-19 infections (1–3). Currently, WBE is a promising indicator to support public health decisions (3,4). In this case study, WBE was used to detect a COVID-19 outbreak in a student dormitory (henceforth Dorm A) at the University of Arizona (UArizona).The StudyUArizona incorporated wastewater surveillance as a potential early-warning tool for COVID-19 outbreaks on campus. Grab samples (1L) were collected from a sewer manhole specific to Dorm A, between August 18-31 to monitor SARS-CoV-2 RNA in wastewater. Upon positive detection of viral RNA in wastewater samples, clinical testing was conducted on every individual living in the dorm. UArizona performed two clinical testing modalities, antigen (1 hour turnaround) test via anterior nasal swab and RT-PCR (48-72 hour turnaround) via nasopharyngeal swab samples. Individuals were subject to clinical testing via two routes: Campus Health Services (CHS) if experiencing symptoms or Test All Test Smart (TATS) regardless of symptoms. Refer to Appendix for method details.Article Summary LineWastewater-based epidemiology with subsequent clinical testing identified individuals infected with COVID-19 living in a dormitory and further spread of disease was prevented with public health action.

scholarly journals Enumerating asymptomatic COVID-19 cases and estimating SARS-CoV-2 fecal shedding rates via wastewater-based epidemiology

2021 ◽  
Author(s):  
Bradley W Schmitz ◽  
Gabriel K Innes ◽  
Sarah M Prasek ◽  
Walter Q Betancourt ◽  
Erika R Stark ◽  
...  
Keyword(s):  
Individual Student ◽  
Nasopharyngeal Swab ◽  
Infection Prevalence ◽  
Clinical Testing ◽  
Fecal Shedding ◽  
Viral Shedding ◽  
University Of Arizona ◽  
Wastewater Samples ◽  
Almost All ◽  
The University

Wastewater-based epidemiology (WBE) was utilized to monitor SARS-CoV-2 RNA in sewage collected from manholes specific to individual student dormitories (dorms) at the University of Arizona in the fall semester of 2020, which led to successful identification and reduction of transmission events. Positive wastewater samples triggered clinical testing of almost all residents within that dorm; thus, SARS-CoV-2 infected individuals were identified regardless of symptom expression. This current study examined clinical testing data to determine the abundance of asymptomatic versus symptomatic cases in these defined communities. Nasal and nasopharyngeal swab samples processed via antigen and PCR tests indicated that 79.2% of SARS-CoV-2 infections were asymptomatic, and only 20.8% of positive cases reported COVID-19 symptoms at the time of testing. Clinical data was paired with corresponding wastewater virus concentrations, which enabled calculation of viral shedding rates in feces per infected person(s). Mean shedding rates averaged from positive wastewater samples across all dorms were 6.84 ± 0.77 log10 genome copies per gram of feces (gc/g-feces) based on the N1 gene and 7.74 ± 0.53 log10 gc/g-feces based on the N2 gene. Quantification of SARS-CoV-2 fecal shedding rates from infected persons has been the critical missing component necessary for WBE models to measure and predict SARS-CoV-2 infection prevalence in communities. The findings from this study can be utilized to create models that can be used to inform public health prevention and response actions.

scholarly journals The pharmacist’s role in disaster research response

2020 ◽  
Vol 77 (13) ◽  
pp. 1054-1059
Author(s):  
Christopher J Edwards ◽  
Aubrey Miller ◽  
J Perren Cobb ◽  
Brian L Erstad
Keyword(s):  
Public Health ◽  
Pharmacy Practice ◽  
Population Based ◽  
National Institutes Of Health ◽  
Disaster Research ◽  
High Quality Research ◽  
Public Health Emergencies ◽  
Research Areas ◽  
University Of Arizona ◽  
The University

Abstract Purpose The need for high-quality research during disaster responses has been well described in the literature, and such research is supported by efforts at the federal level through the National Institutes of Health Disaster Research Response (DR2) Program. This article describes the fourth DR2 workshop with a specific focus on opportunities for pharmacists to get involved with disaster research efforts. Summary Pharmacists have historically played a significant role in disaster planning and response, and there are a number of opportunities for pharmacists to bring their unique perspective, positioning, and skills to disaster research response (ie, onsite and other research on the medical and public health aspects of disasters and public health emergencies). In February 2019, the fourth DR2 workshop was held in Tucson, AZ, in conjunction with the University of Arizona College of Medicine–Tucson, the university’s Mel and Enid Zuckerman College of Public Health, University of Arizona College of Pharmacy, and the university’s Bio5 Institute to explore clinical and population-based research in a simulated disaster setting. This article describes the workshop and discusses several opportunities for pharmacists to design, lead, and support research efforts during disaster scenarios through involvement in research areas including clinical, operational, educational, and logistic aspects of pharmacy practice. Conclusion Due to their positioning throughout health systems, unique perspective, training, and skills, pharmacists are uniquely situated to play an important role in disaster research response.

scholarly journals COVID-19, Australia: Epidemiology Report 12: Reporting week ending 23:59 AEST 19 April 2020

2020 ◽  
Vol 44 ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
Disease Transmission ◽  
Case Fatality ◽  
The United States ◽  
International Travel ◽  
World Health ◽  
Public Health Response ◽  
Public Health Action ◽  
Case Ascertainment ◽  
Overseas Travel

Confirmed cases in Australia notified up to 19 April 2020: notifications = 6,606; deaths = 69. The reduction in international travel and domestic movement, social distancing measures and public health action have likely slowed the spread of the disease. Notifications in Australia remain predominantly among people with recent overseas travel, with some locally-acquired cases being detected. Most locally-acquired cases can be linked back to a confirmed case, with a small portion unable to be epidemiologically linked. The distribution of overseas-acquired cases to locally-acquired cases varies by jurisdiction. The crude case fatality rate (CFR) in Australia remains low (1.0%) compared to the World Health Organization’s globally-reported rate (6.8%) and to other comparable high-income countries such as the United States of America (4.7%) and the United Kingdom (13.5%). The low CFR is likely reflective of high case ascertainment including detection of mild cases. High case ascertainment enables public health response and reduction of disease transmission. Internationally, cases continue to increase. The rates of increase have started to slow in several regions, although it is too soon to tell whether this trend will be sustained. Interpretation of international epidemiology should be conducted with caution as it differs from country to country depending not only on the disease dynamics, but also on differences in case detection, testing and implemented public health measures.

scholarly journals Can Wastewater be Used to Improve our COVID-19 Surveillance Efforts?

CommonHealth ◽  
2020 ◽  
Vol 1 (3) ◽  
pp. 141-147
Author(s):  
Shannon McGinnis ◽  
Shane Mclouglin ◽  
Tiffany Buturla ◽  
Nishita D'Souza ◽  
José Logo ◽  
...  
Keyword(s):  
Public Health ◽  
Control Strategies ◽  
Population Level ◽  
The United States ◽  
Control Measures ◽  
Clear Understanding ◽  
Health Control ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Wastewater Samples

As the spread of COVID-19 continues to significantly impact daily life in the United States and globally, there is a need for a clear understanding of disease prevalence in communities. Traditional methods that rely on counting individual cases often result in underreporting due to limited access to testing or healthcare. This issue is further exacerbated by the spread of COVID-19 by asymptomatic or presymptomatic individuals who may not seek testing. Historically, wastewater surveillance has been used to provide population-level data on the prevalence of infectious diseases in communities. Data collected through wastewater surveillance has been used to advise public health control measures, such as vaccination campaigns, and to detect local outbreaks before cases are reported to public health authorities. For this reason, researchers around the globe have been analyzing wastewater samples for SARS-CoV-2 to assist in our response to the existing COVID-19 pandemic. This commentary discusses the potential utility of wastewater-based surveillance to advise public health control strategies for COVID-19 and discusses how it may be used to strengthen local surveillance efforts in Philadelphia.

scholarly journals Past and Future Alcohol-Attributable Mortality in Europe

2020 ◽  
Vol 17 (23) ◽  
pp. 9024
Author(s):  
Fanny Janssen ◽  
Shady El Gewily ◽  
Anastasios Bardoutsos ◽  
Sergi Trias-Llimós
Keyword(s):  
Public Health ◽  
Western Europe ◽  
Population Level ◽  
European Countries ◽  
Attributable Mortality ◽  
Public Health Issue ◽  
Public Health Action ◽  
Health Action ◽  
North Western ◽  
Careful Assessment

Although alcohol consumption is an important public health issue in Europe, estimates of future alcohol-attributable mortality for European countries are rare, and only apply to the short-term future. We project (age-specific) alcohol-attributable mortality up to 2060 in 26 European countries, after a careful assessment of past trends. For this purpose we used population-level country-, sex-, age- (20–84) and year-specific (1990–2016) alcohol-attributable mortality fractions (AAMF) from the Global Burden of Disease (GBD) study, which we adjusted at older ages. To these data we apply an advanced age-period-cohort projection methodology, that avoids unrealistic future differences and crossovers between sexes and countries. We project that in the future, AAMF levels will decline in all countries, and will converge across countries and sexes. For 2060, projected AAMF are, on average, 5.1% among men and 1.4% among women, whereas in 2016 these levels were 10.1% and 3.3%, respectively. For men, AAMF is projected to be higher in Eastern and South-western Europe than in North-western Europe. All in all, the share of mortality due to alcohol is projected to eventually decline in all 26 European countries. Achieving these projected declines will, however, require strong ongoing public health action, particularly for selected Eastern and North-western European countries.

scholarly journals A sensitive and rapid wastewater test for SARS-COV-2 and its use for the early detection of a cluster of cases in a remote community

2022 ◽  
Author(s):  
Jade Daigle ◽  
Kathleen Racher ◽  
Justin Hazenberg ◽  
Allan Yeoman ◽  
Heather Hannah ◽  
...  
Keyword(s):  
Public Health ◽  
Limit Of Detection ◽  
Detection Threshold ◽  
Rapid Test ◽  
Clinical Testing ◽  
Remote Communities ◽  
Public Health Response ◽  
Public Health Action ◽  
Remote Community ◽  
Surveillance Programs

Throughout the COVID-19 pandemic, wastewater surveillance has been used to monitor trends in SARS-CoV-2 prevalence in the community. A major challenge in establishing wastewater surveillance programs, especially in remote areas, is the need for a well-equipped laboratory for sample analysis. Currently, no options exist for rapid, sensitive, mobile, and easy-to-use wastewater tests for SARS-CoV-2. The performance of the GeneXpert System, which offers cartridge-based, rapid molecular clinical testing for SARS-CoV-2 in a portable platform, was evaluated using wastewater as the input. The GeneXpert demonstrated a SARS-CoV-2 limit of detection in wastewater below 32 copies/mL with a sample processing time of less than an hour. Using wastewater samples collected from multiple sites across Canada during February and March 2021, a high overall agreement (97.8%) was observed between the GeneXpert assay and laboratory-developed tests regarding the presence or absence of SARS-CoV-2. Additionally, with the use of centrifugal filters the detection threshold of the GeneXpert system was improved to <10 copies/mL in wastewater. Finally, to support on-site wastewater surveillance, GeneXpert testing was implemented in Yellowknife, a remote community in Northern Canada where its use successfully alerted public health authorities to undetected transmission of COVID-19. The identification of SARS-CoV-2 in wastewater triggered clinical testing of recent travelers and identification of new COVID-19 cases/clusters. Taken together, these results suggest the GeneXpert is a viable option for surveillance of SARS-CoV-2 in wastewater in locations that do not have access to established testing laboratories. Importance: Wastewater-based surveillance is a powerful tool that provides an unbiased measure of COVID-19 prevalence in a community. This work describes a sensitive wastewater rapid test for SARS-CoV-2 based on a widely distributed technology, the GeneXpert. The advantages of an easy-to-use wastewater test for SARS-CoV-2 are clear – it supports surveillance in remote communities, improves access to testing, and provides faster results allowing for an immediate public health response. The application of wastewater rapid testing in a remote community facilitated the detection of a COVID-19 cluster and triggered public health action, clearly demonstrating the utility of this technology. Wastewater surveillance will become increasingly important in the post-vaccination pandemic landscape as individuals with asymptomatic/mild infections continue transmitting SARS-CoV-2 but are unlikely to be tested.

scholarly journals COVID-19, Australia: Epidemiology Report 13: Reporting week ending 23:59 AEST 26 April 2020

2020 ◽  
Vol 44 ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
Disease Transmission ◽  
Case Fatality ◽  
The United States ◽  
International Travel ◽  
World Health ◽  
Public Health Response ◽  
Public Health Action ◽  
Case Ascertainment ◽  
Overseas Travel

Confirmed cases in Australia notified up to 26 April 2020: notifications = 6,711; deaths = 77. The reduction in international travel and domestic movement, social distancing measures and public health action have likely slowed the spread of COVID-19 in Australia. Notifications in Australia remain predominantly among people with recent overseas travel, with some locally-acquired cases being detected. Most locally-acquired cases can be linked back to a confirmed case, with a small portion unable to be epidemiologically linked to another case. The ratio of overseas-acquired cases to locally-acquired cases varies by jurisdiction. The crude case fatality rate (CFR) in Australia remains low (1.1%) compared to the World Health Organization’s globally-reported rate (6.9%) and to other comparable high-income countries such as the United States of America (5.1%) and the United Kingdom (13.7%). The lower CFR in Australia is likely reflective of high case ascertainment including detection of mild cases. High case ascertainment and prompt identification of contacts enables an effective public health response and a reduction of disease transmission. Internationally, cases continue to increase. The rates of increase have started to slow in several regions, although it is too soon to tell whether this trend will be sustained. Interpretation of international epidemiology should be conducted with caution as it differs from country to country depending not only on the disease dynamics, but also on differences in case detection, testing and implemented public health measures.

scholarly journals SARS-CoV-2 Rapid Antigen Testing of Symptomatic and Asymptomatic Individuals on the University of Arizona Campus

Biomedicines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 539
Author(s):  
David T. Harris ◽  
Michael Badowski ◽  
Brandon Jernigan ◽  
Ryan Sprissler ◽  
Taylor Edwards ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Antigen Test ◽  
University Campuses ◽  
University Of Arizona ◽  
The Us ◽  
Asymptomatic Individuals ◽  
Asymptomatic Subjects ◽  
The University ◽  
Antigen Testing ◽  
Public Demand

SARS-CoV-2, the cause of COVID19, has caused a pandemic that has infected a pandemic that has infected more than 80 M and killed more than 1.6 M persons worldwide. In the US as of December 2020, it has infected more than 32 M people while causing more than 570,000 deaths. As the pandemic persists, there has been a public demand to reopen schools and university campuses. To consider these demands, it is necessary to rapidly identify those individuals infected with the virus and isolate them so that disease transmission can be stopped. In the present study, we examined the sensitivity of the Quidel Rapid Antigen test for use in screening both symptomatic and asymptomatic individuals at the University of Arizona from June to August 2020. A total of 885 symptomatic and 1551 asymptomatic subjects were assessed by antigen testing and real-time PCR testing. The sensitivity of the test for both symptomatic and asymptomatic persons was between 82 and 90%, with some caveats.

scholarly journals Retrospective epidemiological analysis of SARS-CoV-2 wastewater surveillance and case notifications data – New South Wales, Australia, 2020

2021 ◽  
Author(s):  
H. S. Camphor ◽  
S. Nielsen ◽  
Z. Bradford-Hartke ◽  
K. Wall ◽  
R. Broome
Keyword(s):  
Population Level ◽  
Viral Detection ◽  
Notification Rate ◽  
Public Health Action ◽  
Virus Shedding ◽  
South Wales ◽  
Catchment Areas ◽  
Health Action ◽  
Wastewater Samples ◽  
Low Prevalence

Abstract This epidemiological study analysed SARS-CoV-2 wastewater surveillance and case notifications data to inform evidence-based public health action in NSW. We investigated measures of association between SARS-CoV-2 RNA fragments detected in wastewater samples (n=100) and case notifications (n=1,367, as rates per 100,000 population) within wastewater catchment areas (n=6); and evaluated the performance of wastewater testing as a population-level diagnostic tool. Furthermore, we modelled SARS-CoV-2 RNA fragment detection in wastewater given the case notification rate using logistic regression. The odds of a viral detection in wastewater samples increased by a factor of 5.68 (95% CI: 1.51–32.1, P=0.004) with rates of one or more notified cases within a catchment. The diagnostic specificity of wastewater viral detection results was 0.88 (95% CI: 0.69–0.97); the overall diagnostic sensitivity was 0.44 (95% CI: 0.33–0.56). The probability of a viral detection result in wastewater exceeded 50% (95% CI: 36–64%) once the case rate within a catchment exceeded 10.5. Observed results suggest that in a low prevalence setting, wastewater viral detections are a more reliable indicator of the presence of recent virus shedding cases in a catchment, than non-detect results are of the absence of cases in a catchment.

scholarly journals RT-qPCR detection of SARS-CoV-2 mutations S 69-70 del, S N501Y and N D3L associated with variants of concern in Canadian wastewater samples

2021 ◽  
Author(s):  
Shelley W Peterson ◽  
Ravinder Lidder ◽  
Jade Daigle ◽  
Quinn Wonitowy ◽  
Audra Nagasawa ◽  
...  
Keyword(s):  
Public Health ◽  
Early Warning ◽  
Population Level ◽  
N Gene ◽  
Allelic Discrimination ◽  
Molecular Surveillance ◽  
Screening And Surveillance ◽  
Relative Quantitation ◽  
Clinical Surveillance ◽  
Wastewater Samples

SARS-CoV-2 variants of concern (VoC) have been increasingly detected in clinical surveillance in Canada and internationally. These VoC are associated with higher transmissibility rates and in some cases, increased mortality. In this work we present a national wastewater survey of the distribution of three SARS-CoV-2 mutations found in the B.1.1.7, B.1.351, and P.1 VoC, namely the S-gene 69-70 deletion, N501Y mutation, and N-gene D3L. RT-qPCR allelic discrimination assays were sufficiently sensitive and specific for detection and relative quantitation of SARS-CoV-2 variants in wastewater to allow for rapid population-level screening and surveillance. We tested 261 samples collected from 5 Canadian cities (Vancouver, Edmonton, Toronto, Montreal, and Halifax) and 6 communities in the Northwest Territories from February 16th to March 28th, 2021. VoC were not detected in the Territorial communities, suggesting the absence of VoC SARS-CoV-2 cases in those communities. Percentage of variant remained low throughout the study period in the majority of the sites tested, however the Toronto sites showed a marked increase from ~25% to ~75% over the study period. The results of this study highlight the utility of population level molecular surveillance of SARS-CoV-2 VoC using wastewater. Wastewater monitoring for VoC can be a powerful tool in informing public health responses, including monitoring trends independent of clinical surveillance and providing early warning to communities.

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