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. 2022 Nov 9;12(1):19085.
doi: 10.1038/s41598-022-21354-6.

Assessment of a mass balance equation for estimating community-level prevalence of COVID-19 using wastewater-based epidemiology in a mid-sized city

Andrew L Rainey  1   2 , Julia C Loeb  1   2 , Sarah E Robinson  1   2   3 , Paul Davis  4 , Song Liang  1   2 , John A Lednicky  1   2 , Eric S Coker  1 , Tara Sabo-Attwood  1   2   3 , Joseph H Bisesi Jr  5   6   7 , Anthony T Maurelli  8   9
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Assessment of a mass balance equation for estimating community-level prevalence of COVID-19 using wastewater-based epidemiology in a mid-sized city

Andrew L Rainey et al. Sci Rep. .

Abstract

Wastewater-based epidemiology (WBE) has emerged as a valuable epidemiologic tool to detect the presence of pathogens and track disease trends within a community. WBE overcomes some limitations of traditional clinical disease surveillance as it uses pooled samples from the entire community, irrespective of health-seeking behaviors and symptomatic status of infected individuals. WBE has the potential to estimate the number of infections within a community by using a mass balance equation, however, it has yet to be assessed for accuracy. We hypothesized that the mass balance equation-based approach using measured SARS-CoV-2 wastewater concentrations can generate accurate prevalence estimates of COVID-19 within a community. This study encompassed wastewater sampling over a 53-week period during the COVID-19 pandemic in Gainesville, Florida, to assess the ability of the mass balance equation to generate accurate COVID-19 prevalence estimates. The SARS-CoV-2 wastewater concentration showed a significant linear association (Parameter estimate = 39.43, P value < 0.0001) with clinically reported COVID-19 cases. Overall, the mass balance equation produced accurate COVID-19 prevalence estimates with a median absolute error of 1.28%, as compared to the clinical reference group. Therefore, the mass balance equation applied to WBE is an effective tool for generating accurate community-level prevalence estimates of COVID-19 to improve community surveillance.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The wastewater service map of Gainesville, FL. The Gainesville Regional Utility (GRU) divider line running through the center of the city separates the service area for the two water reclamation facilities (WRF) that services the east (Main Street WRF) and west (Kanapaha WRF) areas of Gainesville, FL. The shaded blue area in the figure denotes the area of the University of Florida which has an on-campus WRF that independently services the area.
Figure 2
Figure 2
Weekly COVID-19 clinical case incidence and overall SARS-CoV-2 wastewater concentration (Log10 GC/L) in Gainesville, FL between May 26, 2020 and May 30, 2021.
Figure 3
Figure 3
Linear association of the SARS-CoV-2 wastewater concentration (Log10 GC/L) and weekly COVID-19 clinical incidence (A) and weekly COVID-19 clinical prevalence (B) between May 26, 2020 and May 30, 2021 in Gainesville, FL.
Figure 4
Figure 4
Estimated COVID-19 prevalence estimates between May 26, 2020 and May 30, 2021 in Gainesville, FL. The COVID-19 clinical prevalence is derived from the FL DOH weekly test positivity rate and the Model A (I = 8.9 Log10 GC/g feces) wastewater prevalence was calculated by using the mass balance equation.
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