WASTEWATER-BASED
EPIDEMIOLOGY (WBE)

To most people, wastewater is anything but an exciting topic. Things change dramatically when we understand that our wastewater is one of the most reliable sources of information in connection with the surveillance of infectious diseases, drug abuse or microbial resistance.

Wastewater-Based Epidemiology – or just WBE – is an effective epidemiological tool helping to complement other established approaches of surveillance. It can even serve as an early warning system for these kinds of threats to our society – including COVID-19.

The idea of WBE is simple: through the analysis of wastewater, infectious diseases or antibiotic resistance spread can be monitored comprehensively, in real-time and with less costs than e.g. via individual clinical testing. Monitoring can be implemented either at community or even neighborhood/building level.

WBE already significantly helped the WHO in their polio eradication program and it has been implemented to monitor illegal drug use. Right now the main focus is on helping to fight COVID-19, but it can and will be a relevant method to monitor other pathogens as well – like hepatitis virus, norovirus, enterovirus and even multi-resistant bacteria.

HOW IT WORKS

Why is wastewater such an important source of information? The reason is simple – whenever we use our bathrooms, our sheddings
transport the pathogens or substances that have entered our bodies. Viruses, bacteria, drugs –it all ends up in the wastewater.

The more people in a community are infected, the higher the concentration will be – supplying an indication on the viral load within that community.

TRACING AND MAPPING

Using the correlation between viral load and incidence, it is possible to find out what is happening in our communities, sometimes even before people actually get sick. In this way, it is possible to trace a disease outbreak. If multiple sites are used for monitoring, a more detailed mapping of the outbreak is possible as well.

WBE can even work as an early warning sign when new variants appear – as currently in the COVID-19 crisis. The same applies for the waves of infections: the earlier the beginning of a new wave can be detected, the lower it can be kept by applying appropriate measures.

Wherever infectious diseases are beginning to spread, authorities need to make decisions. Some of these decisions are quite drastic – such as quarantine or even the closing of shops and entertainment facilities. These decisions need to be based on reliable data – both as an explanation of measures and as a way to monitor their effectiveness.

WBE has the power to provide local authorities with specific and reliable data and complement other sources of information in a significant way. And inuvai has the products to support this important mission.

WBE and COVID-19

WASTEWATER-BASED
EPIDEMIOLOGY AND COVID-19

The spreading of the SARS-CoV-2 virus and the occurrence of new variants is mostly monitored by individual clinical testing (PCR or antigen tests), by the number of hospital admissions and by recording the diagnoses of physicians.

As helpful as these approaches may be, they can have some shortcomings:

  • When testing is based on the occurrence of symptoms of a disease, this can lead to an underestimation of the true incidence as asymptomatic cases are not recorded.
  • Individual clinical testing is expensive – both due to the high number of tests that need to be administered and the infrastructure that needs to be provided.
  • As soon as the number of cases is decreasing, testing infrastructure is expected to be cut down / reduced at some point in time.
  • In order to detect new variants individual test samples need to be sequenced which is often not done to an extent that would provide early warning signs of new variants of concern (VOC).

WASTEWATER-BASED EPIDEMIOLOGY
AS AN EARLY INDICATOR

Studies have shown that infection with SARS-CoV-2 is accompanied by persistent shedding of virus RNA in feces in many patients – and that WBE results show a high level of correlation with reported cases of incidence.

Consequently, WBE has the potential to overcome some of the shortcomings of established monitoring approaches:

  • WBE allows for an “automated” sampling of complete communities – independent of people’s willingness to get tested, and without having to set up the necessary infrastructure.
  • WBE can provide actionable results days and even weeks before hospital admissions are starting to increase.
  • WBE gives communities a very cost-efficient way to monitor overall
    incidence     and VOC (Variants of Concern) occurrence by pooling samples.

EU RECOMMENDATION

The European Commission has recently published a recommendation to establish an EU-wide systematic wastewater surveillance program to fight COVID-19.

WBE – Process and Requirements

SARS-COV-2
WASTEWATER PROTOCOL:
HOW DOES IT WORK?

Click for WBE with inuvai R180
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MONITORING COVID-19 IN COMMUNITIES

In order to fully capture the potential of COVID-19
monitoring, specific criteria should be met:

  • Technically simple and easy to perform
  • Fast and gentle to avoid degradation/disintegration of target molecules
  • Effective concentration method
    (i.e. reduced final volume from large volume sample)
  • High recovery of SARS-CoV-2 from wastewater to make a reliable
    detection     of rare variants possible

These criteria keep labor intensity in monitoring low without compromising the quality of the results. Ideally, methods are standardized and allow a high level of automation.

THE POTENTIAL OF WASTEWATER MONITORING

The inuvai R180 Kit tu support laboratories in concentrating large wastewater samples

THE INUVAI ANSWER:
INUVAI R180 KIT

The inuvai R180 Kit contributes to the global fight against COVID-19 by supporting WBE – specifically by providing effective tools for virus concentration in wastewater samples.
It offers numerous advantages:

  • Processing of large (1-2 l) raw wastewater samples
  • Resulting in a reduced final volume
  • Flexible for combination with subsequent steps already
    established in a lab, such as PEG precipitation
  • Quick, easy and reliable process, using dedicated sterile accessories,
    conveniently packed into a kit
  • Easy transfer between different labs
  • High recovery allows detection of even small quantities/low
    concentrations of virus

Naturally, the R180 Kit not only works for SARS-CoV-2 virus, but also for various other microorganisms (virus, bacteria, parasites) and particles
(e.g. microplastics) – making it a versatile tool for future multi-pathogen or other environmental monitoring.

INUVAI R180 IN PRACTICE

Concentration of SARS-CoV-2 from large volumes of raw wastewater is
enhanced with the inuvai R180 Kit. An independent study in Portugal documented its effectiveness:

  • “The inuvai R180 kit had the best performance, with detection of spiked controls across all samples, average recovery percentages of 64% for SARS-CoV-2 control and 68% for porcine epidemic diarrhea virus (PEDV), with low variability.”
  • “The inuvai R180 enables the scalability of volumes without negative impact on the costs, time for analysis, and recovery/inhibition. Moreover, hollow fiber filters favor the concentration of different microbial taxonomic groups. Such combined features make this technology attractive for usage in environmental waters monitoring.”

Ref: https://www.medrxiv.org/conten...

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