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Pages 21-44

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From page 21...
... In particular, state, tribal, local, and territorial public health professionals; public utilities; and CDC are reviewing the usefulness of wastewater surveillance to inform public health decisions for SARS-CoV-2 as well as potential applications to other infectious pathogens. The surveillance system is also at a point of transition from an ad hoc collection of willing state and local participants seeking all useful information for local emergency pandemic response to a forward-looking national wastewater surveillance system that serves state, tribal, local, territorial, and national public health objectives simul
From page 22...
... In addition, uncertainty remains around the use of wastewater surveillance to inform public health response, particularly how this form of disease monitoring can contribute to and complement traditional public health surveillance through clinical data and syndromic surveillance. BOX 1-4 Statement of Task Phase 1 An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will review community-level wastewater-based disease surveillance and its potential value toward prevention and control of infectious diseases in the United States.
From page 23...
... The first phase, which is the focus of this report, provides an assessment of the usefulness of current community-level wastewater surveillance in the United States and its potential value for infectious disease beyond COVID-19. As explained in the statement of task, in the context of this study, "community-level" wastewater surveillance includes "sampling wastewater-based disease surveillance.
From page 24...
... REPORT STRUCTURE This report describes the usefulness of a robust community-level wastewater surveillance system for the United States and highlights approaches for integrating wastewater surveillance data into a public health response for a variety of pathogens. Chapter 2 provides a retrospective assessment of how wastewater surveillance was used in understanding and informing the public health response during the COVID-19 pandemic, including early challenges that were encountered.
From page 25...
... Although the committee's task (and the National Wastewater Surveillance System [NWSS]
From page 26...
... Wastewater surveillance has been increasingly used to supplement these conventional data sources as it addresses some of the information gaps. Regardless of symptomatic status, a large fraction of individuals infected with SARS-CoV-2 shed virus through their stool (Zhang et al., 2021)
From page 27...
... In the following sections, the committee reviews how wastewater surveillance has been useful in understanding COVID-19 data trends and spatial distribution in communities, the spread of variants, and the potential for early warning. Data Trends Early work on wastewater surveillance of COVID-19 sought to demonstrate that wastewater concentrations correlated with case data collected through standard surveillance.
From page 28...
... . NOTE: Data are normalized against concentrations of the pepper mild mottle virus (PMMoV)
From page 29...
... /person/day) in wastewater compared to polymerase chain reaction positive case count in Milwaukee Municipal Sanitation District South Shore, Wisconsin.
From page 30...
... Vaccination status, for example, may change the shedding levels and dynamics with infection, which would ultimately change the viral trends observed in a sewershed's wastewater. There is an interest in using wastewater to estimate the overall COVID-19 disease burden in communities rather than simply using cor relations to predict incidence or hospitalization trends (McMahan et al., 2021; Soller et al., 2022)
From page 31...
... A hypothetical timeline with the major surveillance steps is presented in Figure 2-4. Multiple studies have retroactively evaluated the temporal relationship between increases in SARS-CoV-2 RNA in wastewater and reported FIGURE 2-4 Steps in the reporting of conventional and wastewater surveillance data during the COVID-19 pandemic.
From page 32...
... (2021) also reported no lead time for wastewater surveillance data when sample and clinical specimen collection dates were compared over 12 sewersheds.
From page 33...
... . The value of wastewater surveillance data as a leading indicator of conventional surveillance data can be enhanced at times when there are significant testing delays and case/hospitalization/ death number reporting delays and when wastewater data do not have a significant reporting delay.
From page 34...
... The COVID-19 case data are typically aggregated for the entire county on public health dashboards. Wastewater data from the two communities, which are analyzed with the same methods in the same laboratory, have provided higher spatial resolution compared to the aggregated county case data.
From page 35...
... . Using wastewater surveillance at a subregional scale can provide information about the spread of disease in areas with reduced availability of clinical testing to improve health equity.
From page 36...
... . that are "often underrepresented in clinical testing, such as low-income neighborhoods and communities of color." Comparative analysis of SARS-CoV-2 RNA levels in wastewater across communities is complicated by several factors.
From page 37...
... and genome sequencing -- each of which has specific advantages. PCR-based testing for Alpha, Delta, and Omicron variants has become widely implemented in wastewater surveillance efforts (Kirby et al., 2022; Lee et al., 2021; Schussman et al., 2022; Yu et al., 2022)
From page 38...
... While the time from sample collection to results is still longer than a standard PCR test, the time gap between the two is closing. Wastewater surveillance has in some cases provided information on variants prior to clinical data.
From page 39...
... (2022) demonstrated that variants of concern could be identified in wastewater via high-resolution genome sequencing up to 2 weeks prior to their detection in clinical samples.4 USE IN INFORMING PUBLIC HEALTH ACTIONS In this section, the committee discusses the usefulness of wastewater surveillance data to inform public health decision making and to enhance public awareness of COVID-19 disease transmission, thereby informing public health–related actions.
From page 40...
... Many universities and correctional facilities used this tool to trigger individual testing efforts to identify infected individuals and iso late those who tested positive, which helped in preventing an outbreak and saved resources. Wastewater surveillance provided advanced warning to public health officials, providing a lead time to take measures and control a potential outbreak.
From page 41...
... The Univer sity of Arizona was also able to track the effectiveness of interventions like the stay-at-home policy using wastewater surveillance by foreshadowing a decrease in SARS-CoV-2 RNA levels with a decrease in cases in the subsequent week (Kaiser, 2020)
From page 42...
... Confirming Trends through Comparison with Other Public Health Surveillance Data When analyzed in comparison with other disease surveillance information, wastewater surveillance data are particularly useful in informing public health responses. By using multiple metrics in support of decision making, other sources of data are available to investigate anomalous results and increase confidence in observed trends.
From page 43...
... Informing Public Health Resource Allocation Numerous examples show the value of wastewater surveillance data to inform decisions on the allocation of public health resources, such as testing sites, contact tracing, vaccination centers, and public notification efforts: • In Ohio, a 10-fold increase in SARS-CoV-2 RNA levels within the state's wastewater surveillance system triggered an email warning to state and local health departments, utilities, and community leaders. The notifications were used to inform actions and allocate resources (Kirby et al., 2021)
From page 44...
... . • The City of Davis, California, used wastewater surveillance data to determine where to send geotargeted public health communications (e.g., door hangers, texts, phone calls, emails)


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