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. 2022 Jan:158:106938.
doi: 10.1016/j.envint.2021.106938. Epub 2021 Oct 14.

Wastewater surveillance demonstrates high predictive value for COVID-19 infection on board repatriation flights to Australia

Warish Ahmed  1 , Aaron Bivins  2 , Stuart L Simpson  3 , Paul M Bertsch  4 , John Ehret  5 , Ian Hosegood  5 , Suzanne S Metcalfe  4 , Wendy J M Smith  4 , Kevin V Thomas  6 , Josh Tynan  6 , Jochen F Mueller  6
Affiliations

Wastewater surveillance demonstrates high predictive value for COVID-19 infection on board repatriation flights to Australia

Warish Ahmed et al. Environ Int. 2022 Jan.

Abstract

Controlling importation and transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from overseas travelers is essential for countries, such as Australia, New Zealand, and other island nations, that have adopted a suppression strategy to manage very low community transmission. Wastewater surveillance of SARS-CoV-2 RNA has emerged as a promising tool employed in public health response in many countries globally. This study aimed to establish whether the surveillance of aircraft wastewater can be used to provide an additional layer of information to augment individual clinical testing. Wastewater from 37 long-haul flights chartered to repatriate Australians was tested for the presence of SARS-CoV-2 RNA. Children 5 years or older on these flights tested negative for coronavirus disease 19 (COVID-19) (deep nasal and oropharyngeal reverse-transcription (RT)-PCR swab) 48 h before departure. All passengers underwent mandatory quarantine for 14-day post arrival in Howard Springs, NT, Australia. Wastewater from 24 (64.9 %) of the 37 flights tested positive for SARS-CoV-2 RNA. During the 14 day mandatory quarantine, clinical testing identified 112 cases of COVID-19. Surveillance for SARS-CoV-2 RNA in repatriation flight wastewater using pooled results from three RT-qPCR assays demonstrated a positive predictive value (PPV) of 87.5 %, a negative predictive value (NPV) of 76.9 % and 83.7% accuracy for COVID-19 cases during the post-arrival 14-day quarantine period. The study successfully demonstrates that the surveillance of wastewater from aircraft for SARS-CoV-2 can provide an additional and effective tool for informing the management of returning overseas travelers and for monitoring the importation of SARS CoV-2 and other clinically significant pathogens.

Keywords: Aircraft; COVID-19; Enveloped viruses; Human health risks; SARS-CoV-2; Wastewater surveillance.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Positive predictive value (PPV) and negative predictive value (NPV) of wastewater surveillance of SARS-CoV-2 RNA by RT-qPCR for incident cases of COVID-19 during the 14-day mandatory quarantine period following repatriation flights for CDC N1 assay, CDC N2 assay, China CDC N assay, and all assays.
Fig. 2
Fig. 2
The probability of repatriation flight wastewater sample positive being positive by a single RT-qPCR for CDC N1 (A), CDC N2 (B), China CDC N (C), or All Assays pooled (D) versus the total number of incidents of COVID-19 cases during the mandatory 14-day quarantine. The data for each assay were fit with a cumulative Gaussian distribution, which was then used to estimate the number of infections required for the 95% and 50% probabilities that a single RT-qPCR reaction is positive.
See this image and copyright information in PMC

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