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. 2024 Dec 31;4(12):e0002381.
doi: 10.1371/journal.pgph.0002381. eCollection 2024.

Non-detection of emerging and re-emerging pathogens in wastewater surveillance to confirm absence of transmission risk: A case study of polio in New York

David A Larsen  1 , Dustin Hill  1 , Yifan Zhu  1 , Mohammed Alazawi  2 , Dana Chatila  1 , Christopher Dunham  3 , Catherine Faruolo  1 , Brandon Ferro  4 , Alejandro Godinez  2 , Brianna Hanson  2   5 , Tabassum Insaf  2 , Dan Lang  2 , Dana Neigel  2   5 , Milagros Neyra  1 , Nicole Pulido  1 , Max Wilder  4 , Nan Yang  1 , Brittany Kmush  1 , Hyatt Green  4
Affiliations

Non-detection of emerging and re-emerging pathogens in wastewater surveillance to confirm absence of transmission risk: A case study of polio in New York

David A Larsen et al. PLOS Glob Public Health. .

Abstract

Infectious disease surveillance systems, including wastewater surveillance, can alert communities to the threat of emerging pathogens. We need methods to infer understanding of transmission dynamics from non-detection. We estimate a sensitivity of detection of poliovirus in wastewater to inform the sensitivity of wastewater surveillance for poliovirus using both a clinical epidemiology and fecal shedding approach. We then apply freedom from disease to estimate the sensitivity of the wastewater surveillance network. Estimated sensitivity to detect a single poliovirus infection was low, <11% at most wastewater treatment plants and <3% in most counties. However, the maximum threshold for the number of infections when polio is not detected in wastewater was much lower. Prospective wastewater surveillance can confirm the absence of a polio threat and be escalated in the case of poliovirus detection. These methods can be applied to any emerging or re-emerging pathogen, and improve understanding from wastewater surveillance.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The site positivity of wastewater treatment plants for poliovirus from March through October of 2022.
MGD refers to millions of gallons per day that the wastewater treatment plant is permitted to discharge (larger numbers mean larger populations are represented). This map was created in R version 4.2.3 [24] using county boundaries from the US Census TIGER/Line shapefiles.
Fig 2
Fig 2
The sensitivity of wastewater treatment plants in New York State to a) detect a single poliovirus infection, b) provide confidence in the freedom from poliovirus transmission with three consecutive non-detections, and c) provide 95% confidence in the upper limit of the number of poliovirus infections with three consecutive non-detections. These maps were created in R version 4.2.3 [24] using county boundaries from the US Census TIGER/Line shapefiles.
Fig 3
Fig 3
The sensitivity of New York State’s wastewater surveillance to identify at the county level a) a single poliovirus infection, b) confidence in the freedom from poliovirus transmission with three consecutive non-detections, and c) an upper limit of the number of poliovirus infections given three consecutive non-detections. These maps were created in R version 4.2.3 [24] using county boundaries from the US Census TIGER/Line shapefiles.
Fig 4
Fig 4. Conceptual framework to guide the frequency and scale of testing wastewater for poliovirus.
Baseline prospective surveillance regularly tests wastewater from communities vulnerable to polio outbreaks. Detection prompts a scale-up in surveillance, increasing both the spatial coverage and temporal frequency. Consecutive non-detections prompt scaling back in surveillance, reducing the temporal frequency. Once elimination is confirmed the system returns to baseline prospective surveillance.
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