IWA Young Water Professionals: Spotlight Blog #7

IWA Publishing in conjunction with the International Water Association’s Young Water Professionals is happy to announce the newest post spotlighting the work of Young Water Professionals and showing how the work published in IWA Publishing Journals can be useful to those beginning their careers in the water sector.

Our 7th Young Water Professional's Spotlight Blog comes from James Boxall-Clasby, a PhD candidate based at the UKRI-funded CDT in Sustainable Chemical Technologies at the University of Bath, UK. You can connect with James on LinkedIn or Twitter (@JBoxallClasby).

James had access to our entire journal portfolio for one month, and picked out some interesting papers to discuss, read his thoughts below. A big thank you to James for participating!

An Early Warning System for Infectious Disease Outbreaks: the Rapid Rise of Wastewater-Based Epidemiology for COVID-19 Surveillance

It has been a year since the World Health Organisation declared COVID-19 a pandemic: this outbreak has since highlighted some key areas of weakness in our existing strategies for disease outbreak tracking and control. The rate of infection within communities world-wide has been monitored primarily by testing symptomatic individuals. This has required infected individuals to recognise that they might be infected prior to testing, necessitating a delay in reporting of at least the disease incubation time. There is a further obstacle in the case of the COVID-19 pandemic, as infection can be asymptomatic, resulting in an underestimation in the number of cases.

Assessing the true degree of infection from COVID-19 with minimal delay, both nationally and within individual communities, is essential for disease outbreak management: Wastewater-Based Epidemiology (WBE) is a potential solution to this urgent need. Wastewater is a fingerprint of a community’s health: a pooled sample of its nutrients, biomolecules and microbes. Through the analysis of wastewater, WBE offers an innovative approach for real-time and representative disease outbreak tracking – an approach that overcomes the limitations of lag and underrepresentation present in our existing disease outbreak monitoring strategies.

I am a researcher in this field, currently undertaking a PhD at the University of Bath, UK. By a strange coincidence I started my PhD in October 2019, months before the start of the COVID-19 pandemic. Throughout my PhD I had planned to develop an infectious disease outbreak monitoring methodology to act as an early warning system or surveillance system for future disease outbreaks, but when the scale of the threat posed by COVID-19 became apparent my plans became more urgent for immediate application. Indeed, since March 2020 the importance of WBE as a tool for disease outbreak tracking has become increasingly widely recognised: the majority of work in this area has been published since the COVID-19 pandemic began.

Amidst the fast growth of the field of Wastewater-Based Epidemiology, I was excited to accept an offer from IWA Publishing to read their latest papers and spotlight some of my favourites. Through my reading I have found multiple publications in the field of WBE, between them showing the potential of this field to function as an early-warning system for disease outbreak detection in communities worldwide, as well as a monitoring system for community health.

The first of these papers that I would like to discuss is that written by Yuan et al. in 2016. Through their analysis of wastewater for the detection of 6 antibiotics, Yuan et al. found that antibiotic consumption in the 4 Chinese cities assessed was 12-41 times higher than it was found to be in Italy (Yuan et al., 2016). Thus Wastewater-Based Epidemiology is not only a valuable tool for directly tracking infectious disease outbreak, but also for assessing community health and the release of chemicals into the environment. This makes WBE a valuable resource in the fight against antimicrobial resistance (AMR). This is an essential area of research, as AMR is projected to kill 10 million people per year by the year 2050 (O’Neill, 2014). WBE can be of further use in this area, allowing the quantification not just of antibiotics in wastewater, but also allowing the quantification of the resulting antimicrobial resistance genes (Sims and Kasprzyk-Hordern, 2020).

The other papers that caught my attention have all been published since the pandemic began, each focussing on monitoring the spread of COVID-19 through the use of WBE. Hill et al. (2020), Arora et al. (2020) and Calabria de Araujo et al. (2021) discuss the potential of WBE for global application, with Arora et al. and Calabria de Araujo et al. focussing more on the Indian and Brazilian contexts respectively.

In a quick response to the COVID-19 pandemic in May 2020 Hill et al. reviewed the potential for WBE to support the global fight against the disease. I particularly appreciated the graphical abstract (figure 1), which tidily summarises the advantages of WBE. Firstly that a wastewater sample would identify both asymptomatic and symptomatic cases in that population, and secondly that a sample could represent a population instead of a single individual. The advantages of scale that WBE thus allows are significant: indeed Hill et al. go on to discuss a sampling programme that was set up to allow the continual monitoring of SARS-CoV-2 RNA in community wastewater to allow assessment of the community infection levels in 71% of the Australian state of Victoria: a state with a population of 6.6 million (Hill et al., 2020).

Fig. 1: Graphical abstract reproduced courtesy of Hill et al. (2020), illustrating the advantages of Wastewater-Based Epidemiology as compared to traditional testing. Image available under Open Access under a CC BY 4.0 license.

Throughout 2020 the field of WBE grew at a remarkable rate, with SARS-CoV-2 detection reported in wastewater in countries from the Netherlands (Medema et al., 2020), to the USA (Wu et al., 2020), Australia and Italy,(Ahmed et al., 2020; La Rosa et al., 2021) and many other countries besides. In November 2020, Arora et al. reported the first demonstration of the potential of WBE in India, by which SARS-CoV-2 RNA was detected in wastewater sampled from treatment plants in Jaipur. This is an important piece of work for researchers interested in the environmental variability of the approach for COVID-19 outbreak tracking, as this study demonstrates the continued presence of the SARS-CoV-2 RNA in wastewater at ambient temperatures of 45°C. This observed stability of the target RNA is an important requirement for WBE to become both a world-wide and all-season tool for disease outbreak tracking (Arora et al., 2020).

In December 2020, Calabria de Araujo et al. reviewed the rapid subsequent developments in this field, and discussed the potential of WBE (or as they call it Wastewater-Based Surveillance: WBS) to provide data to help fight the COVID-19 pandemic in low-resource environments with insufficient testing coverage, such as Brazil. Calabria de Araujo et al. particularly noted the need for methods of wastewater sampling from neighbourhoods not connected to the sewerage network. They recommend testing samples in channels and ditches downstream of slums for disease outbreak monitoring. This is a creative solution to a logistical challenge that promises to provide data on community infection without necessitating individual testing (Calabria de Araujo et al., 2021).

I have really enjoyed looking through the range of papers published by IWA Publishing. It speaks to the volume of new and exciting research in this area that among the papers I have discussed here are 3 concerning the immediate global application of Wastewater-Based Epidemiology for disease outbreak tracking.

After the SARS outbreak in 2003, China updated its epidemiological systems to a rapid response to new disease outbreaks (Wang et al., 2008). I speculate that if WBE had been ready at this time, it might have been implemented for the detection of SARS-like RNA targets. This may have provided an opportunity for the early detection and identification of SARS-CoV-2 in late-2019. The global health implications of such a counterfactual advantage are unknowable, but considering the global impact of the COVID-19 pandemic it is my opinion that such a potentially useful tool as WBE must be applied in the future as part of a global surveillance programme for future emergent diseases, in addition to its proposed use in an early-warning system for the re-emergence of COVID-19.

James Boxall-Clasby

PhD Candidate, CDT in Sustainable Chemical Technologies, University of Bath

If you would like to email James, please click jabb22 [at] bath.ac.uk (subject: IWAP%3A%20YWP%20Spotlight%20Blog%20Query) (here).

List of Scientific Papers highlighted from IWA Publishing:

Yuan, S.F., Liu, Z.H., Huang, R.P., Yin, H., and Dang, Z., 2016. Levels of six antibiotics used in China estimated by means of wastewater-based epidemiology. Water Science and Technology, 73(4), pp.769–775. https://doi.org/10.2166/wst.2015.526

Hill, K., Zamyadi, A., Deere, D., Vanrolleghem, P.A., and Crosbie, N.D., 2020. SARS-CoV-2 known and unknowns, implications for the water sector and wastewater-based epidemiology to support national responses worldwide: early review of global experiences with the COVID-19 pandemic. Water Quality Research Journal. https://doi.org/10.2166/wqrj.2020.100

Arora, S., Nag, A., Sethi, J., Rajvanshi, J., Saxena, S., Shrivastava, S.K., and Gupta, A.B., 2020. Sewage surveillance for the presence of SARS-CoV-2 genome as a useful wastewater based epidemiology (WBE) tracking tool in India. Water Science and Technology, 82(12), pp.2823–2836. https://doi.org/10.2166/wst.2020.540

Calabria de Araujo, J., Gavazza, S., Leao, T.L., Florencio, L., da Silva, H.P., Albuquerque, J. de O., de Lira Borges, M.A., de Oliveira Alves, R.B., Rodrigues, R.H.A., and dos Santos, E.B., 2021. SARS-CoV-2 sewage surveillance in low-income countries: potential and challenges. Journal of Water and Health, 19(1), pp.1–19. https://doi.org/10.2166/wh.2020.168

Bibliography:

Ahmed, W., Bivins, A., Bertsch, P.M., Bibby, K., Choi, P.M., Farkas, K., Gyawali, P., Hamilton, K.A., Haramoto, E., Kitajima, M., Simpson, S.L., Tandukar, S., Thomas, K. V., and Mueller, J.F., 2020. Surveillance of SARS-CoV-2 RNA in wastewater: Methods optimization and quality control are crucial for generating reliable public health information. Current Opinion in Environmental Science and Health, 17(100209), pp.82–93. https://doi.org/10.1016/j.coesh.2020.09.003

Medema, G., Heijnen, L., Elsinga, G., Italiaander, R., and Brouwer, A., 2020. Presence of SARS-Coronavirus-2 RNA in Sewage and Correlation with Reported COVID-19 Prevalence in the Early Stage of the Epidemic in the Netherlands. Environmental Science and Technology Letters, 7(7), pp.511–516. https://doi.org/10.1021/acs.estlett.0c00357

O’Neill, J., 2014. Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations.

La Rosa, G., Mancini, P., Bonanno Ferraro, G., Veneri, C., Iaconelli, M., Bonadonna, L., Lucentini, L., and Suffredini, E., 2021. SARS-CoV-2 has been circulating in northern Italy since December 2019: Evidence from environmental monitoring. Science of the Total Environment, 750, p.141711. https://doi.org/10.1101/2020.06.25.20140061

Sims, N. and Kasprzyk-Hordern, B., 2020. Future perspectives of wastewater-based epidemiology: Monitoring infectious disease spread and resistance to the community level. Environment International, 139, p.105689. https://doi.org/10.1016/j.envint.2020.105689

Wang, L., Wang, Y., Jin, S., Wu, Z., Chin, D.P., Koplan, J.P., and Wilson, M.E., 2008. Emergence and control of infectious diseases in China. The Lancet, 372(9649), pp.1598–1605. https://doi.org/10.1016/S0140-6736(08)61365-3

Wu, F., Zhang, J., Xiao, A., Gu, X., Lee, W.L., Armas, F., Kauffman, K., Hanage, W., Matus, M., Ghaeli, N., Endo, N., Duvallet, C., Poyet, M., Moniz, K., Washburne, A.D., Erickson, T.B., Chai, P.R., Thompson, J., and Alm, E.J., 2020. SARS-CoV-2 Titers in Wastewater Are Higher than Expected from Clinically Confirmed Cases. mSystems, 5(4), pp.e00614-20. https://doi.org/10.1128/mSystems.00614-20

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