TY - JOUR
T1 - A multicenter study investigating SARS-CoV-2 in tertiary-care hospital wastewater. viral burden correlates with increasing hospitalized cases as well as hospital-associated transmissions and outbreaks
AU - Acosta, Nicole
AU - Bautista, María A.
AU - Hollman, Jordan
AU - McCalder, Janine
AU - Beaudet, Alexander Buchner
AU - Man, Lawrence
AU - Waddell, Barbara J.
AU - Chen, Jianwei
AU - Li, Carmen
AU - Kuzma, Darina
AU - Bhatnagar, Srijak
AU - Leal, Jenine
AU - Meddings, Jon
AU - Hu, Jia
AU - Cabaj, Jason L.
AU - Ruecker, Norma J.
AU - Naugler, Christopher
AU - Pillai, Dylan R.
AU - Achari, Gopal
AU - Ryan, M. Cathryn
AU - Conly, John M.
AU - Frankowski, Kevin
AU - Hubert, Casey RJ
AU - Parkins, Michael D.
N1 - Funding Information:
This work was supported by grants from the Canadian Institute of Health Research [448242 to M.D.P.]; and Canadian Foundation for Innovation [41054 to C.R.J.H], as well as discretionary start-up funding from the Cumming School of Medicine Infectious Disease Section-Chief Fund (M.D.P.) and Campus Alberta Innovates Program Chair (C.R.J.H). The authors gratefully acknowledge the staff of the City of Calgary and in particular members of Water Services for their continued efforts for sample site planning, maintenance, and collection. The authors are grateful to staff from Alberta Health Services and AHS Infection Prevention and Control for assistance in data collection on patient disposition in the Calgary Zone. The authors also thanks Cameron Semper for providing the pMCSG53 vector and T7/T7 terminator primers, and for providing support with Gibson assembly cloning. We would like to acknowledge the tremendous efforts of Dr Rhonda Clark for program administration and management. The graphical abstract was created with BioRender.
Funding Information:
This work was supported by grants from the Canadian Institute of Health Research [ 448242 to M.D.P.]; and Canadian Foundation for Innovation [41054 to C.R.J.H], as well as discretionary start-up funding from the Cumming School of Medicine Infectious Disease Section-Chief Fund (M.D.P.) and Campus Alberta Innovates Program Chair (C.R.J.H).
Publisher Copyright:
© 2021 The Authors
PY - 2021/8/1
Y1 - 2021/8/1
N2 - SARS-CoV-2 has been detected in wastewater and its abundance correlated with community COVID-19 cases, hospitalizations and deaths. We sought to use wastewater-based detection of SARS-CoV-2 to assess the epidemiology of SARS-CoV-2 in hospitals. Between August and December 2020, twice-weekly wastewater samples from three tertiary-care hospitals (totaling > 2100 dedicated inpatient beds) were collected. Hospital-1 and Hospital-2 could be captured with a single sampling point whereas Hospital-3 required three separate monitoring sites. Wastewater samples were concentrated and cleaned using the 4S-silica column method and assessed for SARS-CoV-2 gene-targets (N1, N2 and E) and controls using RT-qPCR. Wastewater SARS-CoV-2 as measured by quantification cycle (Cq), genome copies and genomes normalized to the fecal biomarker PMMoV were compared to the total daily number of patients hospitalized with active COVID-19, confirmed cases of hospital-acquired infection, and the occurrence of unit-specific outbreaks. Of 165 wastewater samples collected, 159 (96%) were assayable. The N1-gene from SARS-CoV-2 was detected in 64.1% of samples, N2 in 49.7% and E in 10%. N1 and N2 in wastewater increased over time both in terms of the amount of detectable virus and the proportion of samples that were positive, consistent with increasing hospitalizations at those sites with single monitoring points (Pearson's r = 0.679, P < 0.0001, Pearson's r = 0.799, P < 0.0001, respectively). Despite increasing hospitalizations through the study period, nosocomial-acquired cases of COVID-19 (Pearson's r = 0.389, P < 0.001) and unit-specific outbreaks were discernable with significant increases in detectable SARS-CoV-2 N1-RNA (median 112 copies/ml) versus outbreak-free periods (0 copies/ml; P < 0.0001). Wastewater-based monitoring of SARS-CoV-2 represents a promising tool for SARS-CoV-2 passive surveillance and case identification, containment, and mitigation in acute- care medical facilities.
AB - SARS-CoV-2 has been detected in wastewater and its abundance correlated with community COVID-19 cases, hospitalizations and deaths. We sought to use wastewater-based detection of SARS-CoV-2 to assess the epidemiology of SARS-CoV-2 in hospitals. Between August and December 2020, twice-weekly wastewater samples from three tertiary-care hospitals (totaling > 2100 dedicated inpatient beds) were collected. Hospital-1 and Hospital-2 could be captured with a single sampling point whereas Hospital-3 required three separate monitoring sites. Wastewater samples were concentrated and cleaned using the 4S-silica column method and assessed for SARS-CoV-2 gene-targets (N1, N2 and E) and controls using RT-qPCR. Wastewater SARS-CoV-2 as measured by quantification cycle (Cq), genome copies and genomes normalized to the fecal biomarker PMMoV were compared to the total daily number of patients hospitalized with active COVID-19, confirmed cases of hospital-acquired infection, and the occurrence of unit-specific outbreaks. Of 165 wastewater samples collected, 159 (96%) were assayable. The N1-gene from SARS-CoV-2 was detected in 64.1% of samples, N2 in 49.7% and E in 10%. N1 and N2 in wastewater increased over time both in terms of the amount of detectable virus and the proportion of samples that were positive, consistent with increasing hospitalizations at those sites with single monitoring points (Pearson's r = 0.679, P < 0.0001, Pearson's r = 0.799, P < 0.0001, respectively). Despite increasing hospitalizations through the study period, nosocomial-acquired cases of COVID-19 (Pearson's r = 0.389, P < 0.001) and unit-specific outbreaks were discernable with significant increases in detectable SARS-CoV-2 N1-RNA (median 112 copies/ml) versus outbreak-free periods (0 copies/ml; P < 0.0001). Wastewater-based monitoring of SARS-CoV-2 represents a promising tool for SARS-CoV-2 passive surveillance and case identification, containment, and mitigation in acute- care medical facilities.
KW - COVID-19
KW - Hospital-acquired
KW - Sewage
KW - Wastewater
KW - Wastewater-based epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85109044006&partnerID=8YFLogxK
U2 - 10.1016/j.watres.2021.117369
DO - 10.1016/j.watres.2021.117369
M3 - Journal Article
C2 - 34229222
AN - SCOPUS:85109044006
SN - 0043-1354
VL - 201
JO - Water Research
JF - Water Research
M1 - 117369
ER -