Wong Yvonne Hui Min, Lim Jue Tao, Griffiths Jane, Lee Benjamin, Maliki Dzulkhairul, Thompson Janelle, Wong Michelle, Chae Sae-Rom, Teoh Yee Leong, Ho Zheng Jie Marc, Lee Vernon, Cook Alex R, Tay Martin, Wong Judith Chui Ching, Ng Lee Ching
Environmental Health Institute, National Environment Agency, Singapore.
Environmental Health Institute, National Environment Agency, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Sci Total Environ. 2023 Dec 1;902:166446. doi: 10.1016/j.scitotenv.2023.166446. Epub 2023 Aug 19.
Wastewater testing of SARS-CoV-2 has been adopted globally and has shown to be a useful, non-intrusive surveillance method for monitoring COVID-19 trends. In Singapore, wastewater surveillance has been widely implemented across various sites and has facilitated timely COVID-19 management and response. From April 2020 to February 2022, SARS-CoV-2 RNA concentrations in wastewater monitored across three populations, nationally, in the community, and in High Density Living Environments (HDLEs) were aggregated into indices and compared with reported COVID-19 cases and hospitalisations. Temporal trends and associations of these indices were compared descriptively and quantitatively, using Poisson Generalised Linear Models and Generalised Additive Models. National vaccination rates and vaccine breakthrough infection rates were additionally considered as confounders to shedding. Fitted models quantified the temporal associations between the indices and cases and COVID-related hospitalisations. At the national level, the wastewater index was a leading indicator of COVID-19 cases (p-value <0.001) of one week, and a contemporaneous association with hospitalisations (p-value <0.001) was observed. At finer levels of surveillance, the community index was observed to be contemporaneously associated with COVID-19 cases (p-value <0.001) and had a lagging association of 1-week in HDLEs (p-value <0.001). These temporal differences were attributed to differences in testing routines for different sites during the study period and the timeline of COVID-19 progression in infected persons. Overall, this study demonstrates the utility of wastewater surveillance in understanding underlying COVID-19 transmission and shedding levels, particularly for areas with falling or low case ascertainment. In such settings, wastewater surveillance showed to be a lead indicator of COVID-19 cases. The findings also underscore the potential of wastewater surveillance for monitoring other infectious diseases threats.
对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）进行废水检测已在全球范围内采用，并已证明是一种用于监测新冠疫情趋势的有用的、非侵入性监测方法。在新加坡，废水监测已在各个场所广泛实施，并促进了对新冠疫情的及时管理和应对。从2020年4月到2022年2月，对全国、社区和高密度居住环境（HDLEs）这三个人口群体的废水进行监测，将其中SARS-CoV-2 RNA浓度汇总成指数，并与报告的新冠病例数和住院人数进行比较。使用泊松广义线性模型和广义相加模型，对这些指数的时间趋势和相关性进行了描述性和定量比较。此外，还将全国疫苗接种率和疫苗突破性感染率视为病毒脱落的混杂因素。拟合模型量化了指数与病例数以及新冠相关住院人数之间的时间相关性。在国家层面，废水指数是提前一周的新冠病例的领先指标（p值<0.001），并且观察到与住院人数存在同期相关性（p值<0.001）。在更精细的监测层面，观察到社区指数与新冠病例存在同期相关性（p值<0.001），而在高密度居住环境中存在1周的滞后相关性（p值<0.001）。这些时间差异归因于研究期间不同场所的检测程序差异以及感染者新冠病情发展的时间线。总体而言，本研究证明了废水监测在了解新冠病毒潜在传播和病毒脱落水平方面的作用，特别是对于病例确诊数下降或较低的地区。在这种情况下，废水监测显示是新冠病例的领先指标。研究结果还强调了废水监测在监测其他传染病威胁方面的潜力。
