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. 2023 Jun 2:11:1178515.
doi: 10.3389/fpubh.2023.1178515. eCollection 2023.

Wastewater surveillance beyond COVID-19: a ranking system for communicable disease testing in the tri-county Detroit area, Michigan, USA

Zachary Gentry #  1 , Liang Zhao #  1 , Russell A Faust  2 , Randy E David  3 , John Norton  4 , Irene Xagoraraki  1
Affiliations

Wastewater surveillance beyond COVID-19: a ranking system for communicable disease testing in the tri-county Detroit area, Michigan, USA

Zachary Gentry et al. Front Public Health. .

Abstract

Introduction: Throughout the coronavirus disease 2019 (COVID-19) pandemic, wastewater surveillance has been utilized to monitor the disease in the United States through routine national, statewide, and regional monitoring projects. A significant canon of evidence was produced showing that wastewater surveillance is a credible and effective tool for disease monitoring. Hence, the application of wastewater surveillance can extend beyond monitoring SARS-CoV-2 to encompass a diverse range of emerging diseases. This article proposed a ranking system for prioritizing reportable communicable diseases (CDs) in the Tri-County Detroit Area (TCDA), Michigan, for future wastewater surveillance applications at the Great Lakes Water Authority's Water Reclamation Plant (GLWA's WRP).

Methods: The comprehensive CD wastewater surveillance ranking system (CDWSRank) was developed based on 6 binary and 6 quantitative parameters. The final ranking scores of CDs were computed by summing the multiplication products of weighting factors for each parameter, and then were sorted based on decreasing priority. Disease incidence data from 2014 to 2021 were collected for the TCDA. Disease incidence trends in the TCDA were endowed with higher weights, prioritizing the TCDA over the state of Michigan.

Results: Disparities in incidences of CDs were identified between the TCDA and state of Michigan, indicating epidemiological differences. Among 96 ranked CDs, some top ranked CDs did not present relatively high incidences but were prioritized, suggesting that such CDs require significant attention by wastewater surveillance practitioners, despite their relatively low incidences in the geographic area of interest. Appropriate wastewater sample concentration methods are summarized for the application of wastewater surveillance as per viral, bacterial, parasitic, and fungal pathogens.

Discussion: The CDWSRank system is one of the first of its kind to provide an empirical approach to prioritize CDs for wastewater surveillance, specifically in geographies served by centralized wastewater collection in the area of interest. The CDWSRank system provides a methodological tool and critical information that can help public health officials and policymakers allocate resources. It can be used to prioritize disease surveillance efforts and ensure that public health interventions are targeted at the most potentially urgent threats. The CDWSRank system can be easily adopted to geographical locations beyond the TCDA.

Keywords: COVID-19; communicable disease (CD); emerging disease; ranking system; wastewater surveillance.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overall schematic of CDWSRank system. *marked parameter indicates that the annual caseload for Michigan from 2014-2021 was divided by the annual caseload for the TCDA, where the average of those was then taken for downstream analyses. The A+1 value was assigned to those CDs with an average ratio of <1.
Figure 2
Figure 2
Disease incidence (per 100,000) for 95 CDs between 2014 and 2021 in the state of Michigan (Disease incidence for Monkeypox was unavailable during this period).
Figure 3
Figure 3
Comparison of selected CDs incidences (per 100,000) between TCDA and MI (ratio < 1).
Figure 4
Figure 4
Comparison of selected CDs incidences (per 100,000) between TCDA and MI (ratio > 1).
Figure 5
Figure 5
Comparison of selected CDs incidences (per 100,000) between TCDA and MI (ratio ≈ 1).
Figure 6
Figure 6
Selected CDs incidences potentially affected by the COVID-19 pandemic.
Figure 7
Figure 7
Top 30 CDs by CDWSRank system for prospective wastewater surveillance in the TCDA.
See this image and copyright information in PMC

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