Wastewater-based Epidemiology (WBE) for Public Health

Background:

The Covid-19 pandemic highlighted major technological, operational, and social challenges in the UK’s capability to monitor and respond to emerging infectious disease outbreaks. The Accelerated Accessibility Environment (ACE), a Home Office unit within the Homeland Securities Group, launched a national project to explore the potential of wastewater-based epidemiology (WBE) as a “sentinel system”, an early warning system for the detection of new disease outbreaks. The aim of the project was to demonstrate proof of concept for a scalable and sustainable national wastewater monitoring operation that could be used as a surveillance system for infectious diseases and enable rapid and targeted responses to emerging biological threats.

Process:

As part of a Commercial Model Definition Trial (CMDT) within the ACE project, James was tasked with delivering a proof-of-concept deployment model for the monitoring of human viruses in a care home population which could subsequently be scaled into a commercial product. This required the procurement and validation of sample capture technologies and working within a consortium of partners including care home leadership, drainage experts, logistics, epidemiologists, public health experts, laboratory scientists and subject matter expertise to deliver a trial model.

James developed novel wastewater extraction and purification methods capable of reliably and efficiently extracting nucleic acids (DNA and RNA) from viral pathogens in both liquid matrices and solid waste; this method was then deployed in a 12-week practical trial within an operational care home for the elderly.

Outcomes:

1. It was demonstrated that a variety of human viruses (SARS-CoV-2, RSV, influenza A and B, and norovirus) may be shed into wastewater stream from where they could reliably be detected in wastewater liquids, wastewater solids and passive sample capture matrices.

2. A positive signal from this wastewater sentinel system could be used to determine that persons within a facility were infected, enabling a targeted response in the form of focused testing and the rapid identification and isolation of an infected individual from within a population.

3. The trial revealed limitations within the current best practices, as on several occasions a positive wastewater signal was used to identify an undiagnosed individual within the population who had tested negative for a viral disease following the standard personal testing regimen.

An overview of the WBE project is available on the Home Office Accelerated Capability Environment (ACE) blog.