Faculty of Medicine, Center for Child Health-Pediatric Research Office, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Faculty of Medicine, Child Health Department, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
PLoS One. 2022 Oct 14;17(10):e0274793. doi: 10.1371/journal.pone.0274793. eCollection 2022.
Wastewater-based epidemiology (WBE) surveillance as an early warning system (EWS) for monitoring community transmission of SARS-CoV-2 in low- and middle-income country (LMIC) settings, where diagnostic testing capacity is limited, needs further exploration. We explored the feasibility to conduct a WBE surveillance in Indonesia, one of the global epicenters of the COVID-19 pandemic in the middle of 2021, with the fourth largest population in the world where sewer and non-sewered sewage systems are implemented. The feasibility and resource capacity to collect samples on a weekly or fortnightly basis with grab and/or passive sampling methods, as well as to conduct qualitative and quantitative identification of SARS-CoV-2 ribonucleic acid (RNA) using real-time RT-PCR (RT-qPCR) testing of environmental samples were explored.
We initiated a routine surveillance of wastewater and environmental sampling at three predetermined districts in Special Region of Yogyakarta Province. Water samples were collected from central and community wastewater treatment plants (WWTPs), including manholes flowing to the central WWTP, and additional soil samples were collected for the near source tracking (NST) locations (i.e., public spaces where people congregate).
We began collecting samples in the Delta wave of the COVID-19 pandemic in Indonesia in July 2021. From a 10-week period, 54% (296/544) of wastewater and environmental samples were positive for SARS-CoV-2 RNA. The sample positivity rate decreased in proportion with the reported incidence of COVID-19 clinical cases in the community. The highest positivity rate of 77% in week 1, was obtained for samples collected in July 2021 and decreased to 25% in week 10 by the end of September 2021.
A WBE surveillance system for SARS-CoV-2 in Indonesia is feasible to monitor the community burden of infections. Future studies testing the potential of WBE and EWS for signaling early outbreaks of SARS-CoV-2 transmissions in this setting are required.
在诊断检测能力有限的中低收入国家（LMIC）环境中，废水流行病学（WBE）监测作为监测 SARS-CoV-2 社区传播的早期预警系统（EWS），需要进一步探索。我们探讨了在 2021 年中期作为全球 COVID-19 大流行中心之一的印度尼西亚开展 WBE 监测的可行性，印度尼西亚是世界上人口第四多的国家，同时实施了污水和非污水下水道系统。我们探讨了每周或每两周使用采集和/或被动采样方法收集样本的可行性和资源能力，以及使用环境样本的实时 RT-PCR（RT-qPCR）测试对 SARS-CoV-2 核糖核酸（RNA）进行定性和定量鉴定的可行性。
我们在日惹特区的三个预定地区开始对废水和环境样本进行常规监测。水样取自中央和社区污水处理厂（WWTP），包括流向中央 WWTP 的人孔，并且还为近源追踪（NST）地点（即人们聚集的公共场所）收集了额外的土壤样本。
我们于 2021 年 7 月在印度尼西亚 COVID-19 大流行的三角洲波开始收集样本。在 10 周的时间内，54%（296/544）的废水和环境样本对 SARS-CoV-2 RNA 呈阳性。样本阳性率与社区中 COVID-19 临床病例的报告发病率成比例下降。2021 年 7 月采集的样本阳性率最高，为 77%，而到 2021 年 9 月底的第 10 周，阳性率降至 25%。
印度尼西亚 SARS-CoV-2 的 WBE 监测系统能够监测社区感染负担。需要进一步研究测试该系统在该环境中用于早期发现 SARS-CoV-2 传播的潜力。
