Journal Article Epublish
PubMed: 39999204 DOI: 10.1371/journal.pone.0311332
Wastewater surveillance overcomes socio-economic limitations of laboratory-based surveillance when monitoring disease transmission: The South African experience during the COVID-19 pandemic.
PLoS One 20(2):e0311332
Authors: Gillian Maree, Fiona Els, Yashena Naidoo, Laven Naidoo, Phemelo Mahamuza, Mokgaetji Macheke, Nkosenhle Ndlovu, Said Rachida, Chinwe Iwu-Jaja, Setshaba Taukobong, Sibonginkosi Maposa, Kathleen O'Reilly, Mukhlid Yousif, Kerrigan McCarthy
Affiliations
- Gauteng City-Region Observatory (GCRO), a Partnership of the University of Johannesburg, the University of the Witwatersrand, the Gauteng Provincial Government and Organised Local Government in Gauteng (SALGA), Johannesburg, Gauteng, South Africa.
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, Gauteng, South Africa.
- School of Public Health, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
- Centre for Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
- Department of Virology, School of Pathology, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
Abstract
Wastewater and environmental surveillance has been promoted as a communicable disease surveillance tool because it overcomes inherent biases in laboratory-based communicable disease surveillance. Yet, little empirical evidence exists to support this notion, and it remains largely an intuitive, though highly plausible hypothesis. Our interdisciplinary study uses WES data to show evidence for underreporting of SARS-CoV-2 in the context of measurable and statistically significant associations between economic conditions and SARS-CoV-2 incidence and testing rates. We obtained geolocated, anonymised, laboratory-confirmed SARS-CoV-2 cases, wastewater SARS-CoV-2 viral load data and socio-demographic data for Gauteng Province, South Africa. We spatially located all data to create a single dataset for sewershed catchments served by two large wastewater treatment plants. We conducted epidemiological, persons infected and principal component analysis to explore the relationships between variables. Overall, we demonstrate the co-contributory influences of socio-economic indicators on access to SARS-CoV-2 testing and cumulative incidence, thus reflecting that apparent incidence rates mirror access to testing and socioeconomic considerations rather than true disease epidemiology. These analyses demonstrate how WES provides valuable information to contextualise and interpret laboratory-based epidemiological data. Whilst it is useful to have these associations established for SARS-CoV-2, the implications beyond SARS-CoV-2 are legion for two reasons, namely that biases inherent in clinical surveillance are broadly applicable across pathogens and all pathogens infecting humans will find their way into wastewater albeit in varying quantities. WES should be implemented to strengthen surveillance systems, especially where economic inequalities limit interpretability of conventional surveillance data.
MeSH
Research Design, Bias, Laboratories, Incidence, Covid-19, Pandemics, Communicable Diseases