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. 2023 Jun;28(25):2200700.
doi: 10.2807/1560-7917.ES.2023.28.25.2200700.

Patterns of SARS-CoV-2 circulation revealed by a nationwide sewage surveillance programme, the Netherlands, August 2020 to February 2022

Michiel van Boven  1   2 , Wouter A Hetebrij  1 , Arno Swart  1 , Erwin Nagelkerke  1 , Rudolf Fhj van der Beek  1 , Sjors Stouten  1 , Rudolf T Hoogeveen  1 , Fuminari Miura  1   3 , Astrid Kloosterman  1   4 , Anne-Merel R van der Drift  1 , Anne Welling  1 , Willemijn J Lodder  1 , Ana Maria de Roda Husman  1   5
Affiliations

Patterns of SARS-CoV-2 circulation revealed by a nationwide sewage surveillance programme, the Netherlands, August 2020 to February 2022

Michiel van Boven et al. Euro Surveill. 2023 Jun.

Abstract

BackgroundSurveillance of SARS-CoV-2 in wastewater offers a near real-time tool to track circulation of SARS-CoV-2 at a local scale. However, individual measurements of SARS-CoV-2 in sewage are noisy, inherently variable and can be left-censored.AimWe aimed to infer latent virus loads in a comprehensive sewage surveillance programme that includes all sewage treatment plants (STPs) in the Netherlands and covers 99.6% of the Dutch population.MethodsWe applied a multilevel Bayesian penalised spline model to estimate time- and STP-specific virus loads based on water flow-adjusted SARS-CoV-2 qRT-PCR data for one to four sewage samples per week for each of the more than 300 STPs.ResultsThe model captured the epidemic upsurges and downturns in the Netherlands, despite substantial day-to-day variation in the measurements. Estimated STP virus loads varied by more than two orders of magnitude, from ca 1012 virus particles per 100,000 persons per day in the epidemic trough in August 2020 to almost 1015 per 100,000 in many STPs in January 2022. The timing of epidemics at the local level was slightly shifted between STPs and municipalities, which resulted in less pronounced peaks and troughs at the national level.ConclusionAlthough substantial day-to-day variation is observed in virus load measurements, wastewater-based surveillance of SARS-CoV-2 that is performed at high sampling frequency can track long-term progression of an epidemic at a local scale in near real time.

Keywords: SARS-CoV-2; early warning; hospital admissions; qRT-PCR; wastewater-based surveillance.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Sewage treatment plants, the Netherlands, 2022 (n = 317)
Figure 2
Figure 2
SARS-CoV-2 loads in sewage and fit of the model for the largest sewage treatment plants, the Netherlands, August 2020–February 2022 (n = 1,319 data points)
Figure 3
Figure 3
Estimated probability of SARS-CoV-2 RNA detection in sewage samples as a function of the log10-transformed sewage load, the Netherlands, August 2020–February 2022 (n = 1,000 samples from the posterior distribution)
Figure 4
Figure 4
Estimated log-transformed SARS-CoV-2 loads for the nine largest municipalities in the Netherlands with log-transformed number of hospitalisations, the Netherlands, August 2020–February 2022 (n = 19,146 hospital admissions)
Figure 5
Figure 5
Estimated national log-transformed SARS-CoV-2 loads in sewage with national log-transformed daily number of hospitalisations, the Netherlands, August 2020–February 2022 (n = 82,103 hospital admissions)
See this image and copyright information in PMC

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