Jones Gethin, Nelson Andrew, Chadwick David R, Cobley Steve, Jones Davey L, Perrett Stephanie, Perry William Bernard, Weightman Andrew J, Williams Rachel C, Thomas Daniel Rhys
Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, United Kingdom.
School of Environmental and Natural Sciences, Bangor University, Bangor, United Kingdom.
Front Public Health. 2024 Nov 19;12:1462186. doi: 10.3389/fpubh.2024.1462186. eCollection 2024.
Prisons are high-risk settings for the transmission of communicable disease. Robust surveillance systems are required to identify and control outbreaks. Wastewater surveillance for SARS-CoV-2 was introduced in four prisons in Wales in March 2022. We investigated its contribution to the COVID-19 surveillance programme.
We evaluated prison wastewater surveillance against eight system attributes using a mixed-methods approach. Semi-structured interviews were completed with key stakeholders to assess usefulness, flexibility and acceptability. Quantitative analyses were completed to assess data quality, sensitivity, positive-predictive value, representativeness and timeliness. To assess sensitivity of the system to detect changes in incidence we carried out a time-series analysis comparing levels of virus in wastewater with trends in confirmed COVID-19 cases from clinical surveillance.
Interviews with stakeholders indicated that wastewater surveillance is a useful adjunct to existing case-based surveillance. However, it had limited influence on action taken within the prison, often lagging behind existing surveillance and not specific enough to target interventions. The novelty of wastewater surveillance meant stakeholders lacked confidence in interpreting the data. Despite these limitations, wastewater surveillance detected changes in SARS-CoV-2 activity in Welsh prison populations which corroborated trends in case surveillance.
Prison wastewater surveillance, implemented in Wales for a period during the COVID-19 pandemic, was useful and should be considered as part of a wider surveillance programme in response to future SARS-CoV-2 waves, or in response to future pandemics. It is particularly beneficial in the absence of comprehensive clinical testing. We identified several limitations to address should this surveillance be re-started.
监狱是传染病传播的高风险场所。需要强大的监测系统来识别和控制疫情暴发。2022年3月，威尔士的四所监狱引入了针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的废水监测。我们调查了其对新冠肺炎监测计划的贡献。
我们采用混合方法，根据八个系统属性对监狱废水监测进行了评估。与关键利益相关者进行了半结构化访谈，以评估其有用性、灵活性和可接受性。完成了定量分析，以评估数据质量、敏感性、阳性预测值、代表性和及时性。为了评估该系统检测发病率变化的敏感性，我们进行了一项时间序列分析，将废水中的病毒水平与临床监测中确诊的新冠肺炎病例趋势进行比较。
与利益相关者的访谈表明，废水监测是现有基于病例的监测的有益补充。然而，它对监狱内采取的行动影响有限，往往落后于现有监测，且针对性不足以指导干预措施。废水监测的新颖性意味着利益相关者对解读数据缺乏信心。尽管存在这些局限性，废水监测仍检测到了威尔士监狱人群中SARS-CoV-2活动的变化，这与病例监测的趋势相佐证。
在新冠肺炎疫情期间，威尔士实施的监狱废水监测是有用的，应被视为更广泛监测计划的一部分，以应对未来的SARS-CoV-2浪潮或未来的大流行。在缺乏全面临床检测的情况下，它特别有益。我们确定了如果重新启动这种监测需要解决的几个局限性。
