Early warning COVID-19 outbreak in long-term care facilities using wastewater surveillance: correlation, prediction, and interaction with clinical and serological statuses.

Journal

The Lancet. Microbe
ISSN: 2666-5247
Titre abrégé: Lancet Microbe
Pays: England
ID NLM: 101769019

Informations de publication

Date de publication:
22 Aug 2024
Historique:
received: 27 03 2024
revised: 24 04 2024
accepted: 03 05 2024
medline: 26 8 2024
pubmed: 26 8 2024
entrez: 25 8 2024
Statut: aheadofprint

Résumé

The unprecedented COVID-19 pandemic has highlighted the strategic value of wastewater-based surveillance (WBS) of SARS-CoV-2. This multisite 28-month-long study focused on WBS for older residents in 12 long-term care facilities (LTCFs) in Edmonton (AB, Canada) by assessing relationships between COVID-19, WBS, and serostatus during the pandemic. Wastewater samples collected two to three times per week were tested for SARS-CoV-2 using RT-quantitative PCR. The serostatus of antibodies was examined using immunoassays. The data of clinical COVID-19 outbreaks based on extensive testing were obtained from local public health officials. Analyses included calculating correlations between 7-day rolling averages for WBS and COVID-19 cases and investigating whether WBS led or lagged confirmed outbreaks using a multinomial test. Wastewater results correlated well with clinical COVID-19 infections and outbreaks at participating LTCFs. 1058 (36·0%) of 2936 collected wastewater samples were SARS-CoV-2 positive, compared with 1247 people (resident n=671, staff n=572, and unknown n=4) reporting positive test results of 21 673 clinical samples assessed (5·8%). WBS led clinical testing in 32 (60·4%) confirmed outbreaks, which was significantly different from WBS lagged (12 outbreaks [22·6%, 95% CI 11·3-33·7]). Non-detection of WBS SARS-CoV-2 served as a negative predictor for outbreaks. WBS results attested protective immunity in vaccinated individuals before the omicron wave. A parallel increase in the proportions of positive WBS SARS-CoV-2 and anti-nucleocapsid antibodies underlined that omicron was an immunity-evading variant despite high seropositivity of neutralising antibodies after multiple doses of vaccine. Implementation of WBS could enable targeted clinical investigations and improve cost-effectiveness of COVID-19 outbreak management in LTCFs. WBS and serostatus provided informed dynamic changes of infections and immunity. Critical evidence was that LTCF WBS is an effective early warning system to support rapid public health outbreak management and protect vulnerable older populations. Canadian Immunity Task Force for COVID-19 and Alberta Health.

Sections du résumé

BACKGROUND BACKGROUND
The unprecedented COVID-19 pandemic has highlighted the strategic value of wastewater-based surveillance (WBS) of SARS-CoV-2. This multisite 28-month-long study focused on WBS for older residents in 12 long-term care facilities (LTCFs) in Edmonton (AB, Canada) by assessing relationships between COVID-19, WBS, and serostatus during the pandemic.
METHODS METHODS
Wastewater samples collected two to three times per week were tested for SARS-CoV-2 using RT-quantitative PCR. The serostatus of antibodies was examined using immunoassays. The data of clinical COVID-19 outbreaks based on extensive testing were obtained from local public health officials. Analyses included calculating correlations between 7-day rolling averages for WBS and COVID-19 cases and investigating whether WBS led or lagged confirmed outbreaks using a multinomial test.
FINDINGS RESULTS
Wastewater results correlated well with clinical COVID-19 infections and outbreaks at participating LTCFs. 1058 (36·0%) of 2936 collected wastewater samples were SARS-CoV-2 positive, compared with 1247 people (resident n=671, staff n=572, and unknown n=4) reporting positive test results of 21 673 clinical samples assessed (5·8%). WBS led clinical testing in 32 (60·4%) confirmed outbreaks, which was significantly different from WBS lagged (12 outbreaks [22·6%, 95% CI 11·3-33·7]). Non-detection of WBS SARS-CoV-2 served as a negative predictor for outbreaks. WBS results attested protective immunity in vaccinated individuals before the omicron wave. A parallel increase in the proportions of positive WBS SARS-CoV-2 and anti-nucleocapsid antibodies underlined that omicron was an immunity-evading variant despite high seropositivity of neutralising antibodies after multiple doses of vaccine.
INTERPRETATION CONCLUSIONS
Implementation of WBS could enable targeted clinical investigations and improve cost-effectiveness of COVID-19 outbreak management in LTCFs. WBS and serostatus provided informed dynamic changes of infections and immunity. Critical evidence was that LTCF WBS is an effective early warning system to support rapid public health outbreak management and protect vulnerable older populations.
FUNDING BACKGROUND
Canadian Immunity Task Force for COVID-19 and Alberta Health.

Identifiants

DOI: 10.1016/S2666-5247(24)00126-5 PMID: 39182502
pubmed: 39182502
pii: S2666-5247(24)00126-5
doi: 10.1016/S2666-5247(24)00126-5
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

100894

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests We declare no competing interests.

Auteurs

Xiaoli Pang (X)

Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada. Electronic address: xlpang@ualberta.ca.

Bonita E Lee (BE)

Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada; Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.

Tiejun Gao (T)

Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.

Rhonda J Rosychuk (RJ)

Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.

Linnet Immaraj (L)

Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.

Judy Y Qiu (JY)

Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada.

Jiabi Wen (J)

School of Public Health, University of Alberta, Edmonton, AB, Canada.

Nathan Zelyas (N)

Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada.

Krista Howden (K)

Edmonton Zone, Alberta Health Services, Edmonton, AB, Canada.

Janelle Wallace (J)

Edmonton Zone, Alberta Health Services, Edmonton, AB, Canada.

Eleanor Risling (E)

Edmonton Zone, Alberta Health Services, Edmonton, AB, Canada.

Lorie A Little (LA)

Edmonton Zone, Alberta Health Services, Edmonton, AB, Canada.

John Kim (J)

National Microbiology Laboratory, Winnipeg, MB, Canada.

Heidi Wood (H)

National Microbiology Laboratory, Winnipeg, MB, Canada.

Alyssia Robinson (A)

National Microbiology Laboratory, Winnipeg, MB, Canada.

Michael Parkins (M)

Department of Medicine and Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada.

Casey R J Hubert (CRJ)

Department of Biological Sciences, University of Calgary, Calgary, AB, Canada.

Kevin Frankowski (K)

Advancing Canadian Water Assets, University of Calgary, Calgary, AB, Canada.

Steve E Hrudey (SE)

Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.

Christopher Sikora (C)

Department of Medicine, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada; Edmonton Zone, Alberta Health Services, Edmonton, AB, Canada.

Classifications MeSH