Wastewater-based epidemiology for early warning of SARS-COV-2 circulation: A pilot study conducted in Sicily, Italy

There is increasing evidence of the use of wastewater-based epidemiology to integrate conventional monitoring assessing disease symptoms and signs of viruses in a specific territory. We present the results of SARS-CoV-2 environmental surveillance activity in wastewater samples collected between September 2020 and July 2021 in 9 wastewater treatment plants (WTPs) located in central and western Sicily, serving over 570,000 residents. The presence of SARS-CoV-2, determined in 206 wastewater samples using RT-qPCR assays, was correlated with the notified and geo-referenced cases on the areas served by the WTPs in the same study period. Overall, 51% of wastewater samples were positive. Samples were correlated with 33,807 SARS-CoV-2 cases, reported in 4 epidemic waves, with a cumulative prevalence of 5.9% among Sicilian residents. The results suggest that the daily prevalence of SARS-CoV-2 active cases was statistically significant and higher in areas with SARS-CoV-2 positive wastewater samples. According to these findings, the proposed method achieves a good sensitivity profile (78.3%) in areas with moderate or high viral circulation (≥133 cases/100,000 residents) and may represent a useful tool in the management of epidemics based on an environmental approach, although it is necessary to improve the accuracy of the process

A comprehensive one-year correlation analysis between prevalence and number of sars-cov-2 rna copies detected in wastewater from 8 sicilian cities in italy

Background and objectives: Several authors have reported positive correlations between wastewater SARS-CoV-2 concentrations and the community’s burden of infection, providing information about the disease’s epidemiological trend. This pre-post study evaluated – within a year of active surveillance, from October 1st,2021, to September 30th, 2022 – the relation between daily SARSCoV-2 prevalence and the number of genome copies/L detected in West Sicily wastewater samples. This study is part of a national framework coordinated by Istituto Superiore di Sanità. Methods: Quantitative data from analysing 486 wastewater samples collected from 9 purification plants in 8 Sicilian cities (Agrigento, Bagheria, Caltanissetta, Enna, Marsala, Mazara del Vallo, Palermo, and Trapani) were obtained. Correlation and logistic regression analysis were performed between the communal-based aggregated prevalence of daily SARS-CoV-2 cases obtained from the integrated national surveillance system and the number of genomic copies/L derived from wastewater analysis for different times (day-prevalence t0, t7, t14) and different periods (0- to 6-, 6- to 12- and comprehensive 12 months). Results: A moderate-high correlation index was retrieved for 0- to 6- months (October 2021–March 2022, t0: r=0.75, R2=0.57; t7 r=0.76, R2=0.58, t14 r=0.76, R2=0.58) and overall analyses (October 2021–October 2022, t0 r=0.63, R2=0.40; t7 r=0.62, R2=0.38; t14 r=0.59, R2=0.35). On the other hand, 6- to 12- months analysis displayed a relevant decline in correlation (March 2022–October 2022, t0 r=0.19, R2=0.04; t7 r=0.17, R2=0.03, p=0.004; t14 r=0.11, R2=0.01). All data except t14 were statistically significant (p<0.0001). Conclusions: Significance results were displayed for 0- to 6- and overall analysis at 0,7 and 14 days. Despite 6- to 12- months samples tested positive for RNA copies, a progressive loss of significance was found probably mainly attributable to a progressive loss of function in prevalence estimation of the swab-related SARSCoV-2 positivity detecting system due to underreporting of cases

Detection of influenza virus in urban wastewater during the season 2022/2023 in Sicily, Italy

IntroductionSeasonal influenza generally represents an underestimated public health problem with significant socioeconomic implications. Monitoring and detecting influenza epidemics are important tasks that require integrated strategies. Wastewater-based epidemiology (WBE) is an emerging field that uses wastewater data to monitor the spread of disease and assess the health of a community. It can represent an integrative surveillance tool for better understanding the epidemiology of influenza and prevention strategies in public health.MethodsWe conducted a study that detected the presence of Influenza virus RNA using a wastewater-based approach. Samples were collected from five wastewater treatment plants in five different municipalities, serving a cumulative population of 555,673 Sicilian inhabitants in Italy. We used the RT-qPCR test to compare the combined weekly average of Influenza A and B viral RNA in wastewater samples with the average weekly incidence of Influenza-like illness (ILI) obtained from the Italian national Influenza surveillance system. We also compared the number of positive Influenza swabs with the viral RNA loads detected from wastewater. Our study investigated 189 wastewater samples.ResultsCumulative ILI cases substantially overlapped with the Influenza RNA load from wastewater samples. Influenza viral RNA trends in wastewater samples were similar to the rise of ILI cases in the population. Therefore, wastewater surveillance confirmed the co-circulation of Influenza A and B viruses during the season 2022/2023, with a similar trend to that reported for the weekly clinically confirmed cases.ConclusionWastewater-based epidemiology does not replace traditional epidemiological surveillance methods, such as laboratory testing of samples from infected individuals. However, it can be a valuable complement to obtaining additional information on the incidence of influenza in the population and preventing its spread