PDF(Pubmed)
Abstract：
Wastewater-based epidemiology (WBE) emerged during the coronavirus disease 2019 (COVID-19) pandemic as a scalable and broadly applicable method for community-level monitoring of infectious disease burden. The lack of high-resolution fecal shedding data for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) limits our ability to link WBE measurements to disease burden. In this study, we present longitudinal, quantitative fecal shedding data for SARS-CoV-2 RNA, as well as for the commonly used fecal indicators pepper mild mottle virus (PMMoV) RNA and crAss-like phage (crAssphage) DNA. The shedding trajectories from 48 SARS-CoV-2-infected individuals suggest a highly individualized, dynamic course of SARS-CoV-2 RNA fecal shedding. Of the individuals that provided at least three stool samples spanning more than 14 days, 77% had one or more samples that tested positive for SARS-CoV-2 RNA. We detected PMMoV RNA in at least one sample from all individuals and in 96% (352/367) of samples overall. CrAssphage DNA was detected in at least one sample from 80% (38/48) of individuals and was detected in 48% (179/371) of all samples. The geometric mean concentrations of PMMoV and crAssphage in stool across all individuals were 8.7 × 104 and 1.4 × 104 gene copies/milligram-dry weight, respectively, and crAssphage shedding was more consistent for individuals than PMMoV shedding. These results provide us with a missing link needed to connect laboratory WBE results with mechanistic models, and this will aid in more accurate estimates of COVID-19 burden in sewersheds. Additionally, the PMMoV and crAssphage data are critical for evaluating their utility as fecal strength normalizing measures and for source-tracking applications. IMPORTANCE This research represents a critical step in the advancement of wastewater monitoring for public health. To date, mechanistic materials balance modeling of wastewater-based epidemiology has relied on SARS-CoV-2 fecal shedding estimates from small-scale clinical reports or meta-analyses of research using a wide range of analytical methodologies. Additionally, previous SARS-CoV-2 fecal shedding data have not contained sufficient methodological information for building accurate materials balance models. Like SARS-CoV-2, fecal shedding of PMMoV and crAssphage has been understudied to date. The data presented here provide externally valid and longitudinal fecal shedding data for SARS-CoV-2, PMMoV, and crAssphage which can be directly applied to WBE models and ultimately increase the utility of WBE.
摘要：
基于废水的流行病学（WBE）在2019年冠状病毒病（COVID-19）大流行期间出现，作为一种可扩展且广泛适用的方法，用于社区一级的传染病负担监测。严重急性呼吸道综合症冠状病毒2（SARS-CoV-2）缺乏高分辨率的粪便脱落数据限制了我们将WBE测量与疾病负担联系起来的能力。在这项研究中,我们呈现纵向，SARS-CoV-2RNA的定量粪便脱落数据，以及常用的粪便指标辣椒轻度斑驳病毒（PMMoV）RNA和crAss样噬菌体（crAssphage）DNA。48例SARS-CoV-2感染者的脱落轨迹表明，SARS-CoV-2RNA粪便脱落的动态过程。在提供至少三个粪便样本超过14天的个体中，77%的人有一个或多个SARS-CoV-2RNA检测呈阳性的样本。我们在来自所有个体的至少一个样品和96%(352/367)的总体样品中检测到PMMoVRNA。在来自80%(38/48)个体的至少一个样品中检测到CrAssphageDNA,并且在所有样品的48%(179/371)中检测到CrAssphageDNA。所有个体粪便中PMMoV和crAssphage的几何平均浓度分别为8.7×104和1.4×104基因拷贝/毫克干重，分别,与PMMoV脱落相比，CrAssphage脱落对个体更一致。这些结果为我们提供了将实验室WBE结果与机械模型连接所需的缺失环节，这将有助于更准确地估计下水道中的COVID-19负担。此外,PMMoV和crAssphage数据对于评估其作为粪便强度归一化措施和来源跟踪应用的效用至关重要。重要性这项研究代表了推进公共卫生废水监测的关键一步。迄今为止,基于废水的流行病学的机械物料平衡模型依赖于小规模临床报告或使用多种分析方法进行研究的荟萃分析的SARS-CoV-2粪便脱落估计。此外,以前的SARS-CoV-2粪便脱落数据没有包含足够的方法学信息来构建准确的材料平衡模型。与SARS-CoV-2一样，迄今为止对PMMoV和crAssphage的粪便脱落研究不足。这里提供的数据提供了SARS-CoV-2、PMMoV、和crAssphage可以直接应用于WBE模型，并最终增加WBE的效用。
