Robins Katie, Leonard Anne F C, Farkas Kata, Graham David W, Jones David L, Kasprzyk-Hordern Barbara, Bunce Joshua T, Grimsley Jasmine M S, Wade Matthew J, Zealand Andrew M, McIntyre-Nolan Shannon
Environmental Monitoring for Health Protection, UK Health Security Agency, Nobel House, London SW1P 3HX, UK E-mail:
School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW, UK.
J Water Health. 2022 Sep;20(9):1284-1313. doi: 10.2166/wh.2022.026.
Wastewater-based epidemiology (WBE) is an unobtrusive method used to observe patterns in illicit drug use, poliovirus, and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The pandemic and need for surveillance measures have led to the rapid acceleration of WBE research and development globally. With the infrastructure available to monitor SARS-CoV-2 from wastewater in 58 countries globally, there is potential to expand targets and applications for public health protection, such as other viral pathogens, antimicrobial resistance (AMR), pharmaceutical consumption, or exposure to chemical pollutants. Some applications have been explored in academic research but are not used to inform public health decision-making. We reflect on the current knowledge of WBE for these applications and identify barriers and opportunities for expanding beyond SARS-CoV-2. This paper critically reviews the applications of WBE for public health and identifies the important research gaps for WBE to be a useful tool in public health. It considers possible uses for pathogenic viruses, AMR, and chemicals. It summarises the current evidence on the following: (1) the presence of markers in stool and urine; (2) environmental factors influencing persistence of markers in wastewater; (3) methods for sample collection and storage; (4) prospective methods for detection and quantification; (5) reducing uncertainties; and (6) further considerations for public health use.
基于废水的流行病学（WBE）是一种用于观察非法药物使用、脊髓灰质炎病毒和严重急性呼吸综合征冠状病毒2（SARS-CoV-2）模式的非侵入性方法。疫情以及对监测措施的需求促使全球范围内WBE的研发迅速加速。鉴于全球58个国家具备从废水中监测SARS-CoV-2的基础设施，存在扩大公共卫生防护目标和应用的潜力，如其他病毒病原体、抗菌药物耐药性（AMR）、药物消费或化学污染物暴露。一些应用已在学术研究中进行了探索，但尚未用于为公共卫生决策提供信息。我们思考了WBE在这些应用方面的现有知识，并确定了超越SARS-CoV-2进行扩展的障碍和机遇。本文对WBE在公共卫生方面的应用进行了批判性回顾，并确定了WBE成为公共卫生有用工具的重要研究差距。它考虑了致病病毒、AMR和化学物质的可能用途。它总结了以下方面的现有证据：（1）粪便和尿液中标志物的存在情况；（2）影响废水中标志物持久性的环境因素；（3）样本采集和储存方法；（4）检测和定量的前瞻性方法；（5）减少不确定性；以及（6）公共卫生用途的进一步考虑。
