Agile, on-demand wastewater surveillance of virus infections to support pandemic and outbreak response in Rotterdam-Rijnmond, the Netherlands, 2020 to 2022

Abstract

BackgroundWastewater surveillance may support early and comprehensive detection of infectious diseases' community transmission, particularly in settings where other health surveillance systems provide biased or limited information. Amid the SARS-CoV-2 pandemic, deploying passive samplers to monitor targeted populations gained importance. Evaluation of the added public health value of this approach in the field can support its broader adoption.AimWe aimed to assess the feasibility and utility of on-demand wastewater surveillance, employing passive samplers, for SARS-CoV-2 and monkeypox virus (MPXV) in small/targeted populations, also considering ethical aspects.MethodsPilot case studies in the Rotterdam-Rijnmond region were used for a systematic assessment of the feasibility and utility of wastewater monitoring of SARS-CoV-2 (variants) and MPXV using passive sampling. Each case study was instigated by actual questions from the Public Health Service about disease transmission.ResultsCase study results demonstrated the feasibility and utility of on-demand wastewater surveillance with successful identification of a local peak in SARS-CoV-2 transmission, early detection of wider Omicron variant transmission after the first case was reported, as well as indication of no emerging local MPXV transmission. Ethical considerations led to the abandonment of one case study involving a displaced population.ConclusionsThe study confirms the feasibility and utility of passive sampling for real-time infectious disease surveillance, at desired spatiotemporal resolution. Ethical concerns and operational challenges were identified, highlighting the need for early stakeholder engagement and ethical guideline adherence. The method could be used to study under-surveyed populations and be extended beyond SARS-CoV-2 and MPXV to other pathogens.

Keywords: Cities; Disease outbreaks; Mpox virus; SARS-CoV-2; Students; Wastewater; passive samplers.

Figure 1

Correlation between SARS-CoV-2 concentrations from 24-hour passive samplers (y-axis) and the 24-hour volume-proportional wastewater samples for virus capture from wastewater (x-axis)

Figure 2

Normalised SARS-CoV-2 concentration in passive samplers at student residences (case study 4) and monitoring data from the Rotterdam wastewater treatment plant obtained from the national sewage surveillance at RIVM, Rotterdam-Rijnmond, the Netherlands, September 2022–November 2022