Wastewater surveillance overcomes socio-economic limitations of laboratory-based surveillance when monitoring disease transmission: The South African experience during the COVID-19 pandemic.
Wastewater and environmental surveillance has been promoted as a communicable disease surveillance tool because it overcomes inherent biases in laboratory-based communicable disease surveillance. Yet, little empirical evidence exists to support this notion, and it remains largely an intuitive, thoug...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2025-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0311332 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850273625125421056 |
|---|---|
| author | Gillian Maree Fiona Els Yashena Naidoo Laven Naidoo Phemelo Mahamuza Mokgaetji Macheke Nkosenhle Ndlovu Said Rachida Chinwe Iwu-Jaja Setshaba Taukobong Sibonginkosi Maposa Kathleen O'Reilly Mukhlid Yousif Kerrigan McCarthy |
| author_facet | Gillian Maree Fiona Els Yashena Naidoo Laven Naidoo Phemelo Mahamuza Mokgaetji Macheke Nkosenhle Ndlovu Said Rachida Chinwe Iwu-Jaja Setshaba Taukobong Sibonginkosi Maposa Kathleen O'Reilly Mukhlid Yousif Kerrigan McCarthy |
| author_sort | Gillian Maree |
| collection | DOAJ |
| description | Wastewater and environmental surveillance has been promoted as a communicable disease surveillance tool because it overcomes inherent biases in laboratory-based communicable disease surveillance. Yet, little empirical evidence exists to support this notion, and it remains largely an intuitive, though highly plausible hypothesis. Our interdisciplinary study uses WES data to show evidence for underreporting of SARS-CoV-2 in the context of measurable and statistically significant associations between economic conditions and SARS-CoV-2 incidence and testing rates. We obtained geolocated, anonymised, laboratory-confirmed SARS-CoV-2 cases, wastewater SARS-CoV-2 viral load data and socio-demographic data for Gauteng Province, South Africa. We spatially located all data to create a single dataset for sewershed catchments served by two large wastewater treatment plants. We conducted epidemiological, persons infected and principal component analysis to explore the relationships between variables. Overall, we demonstrate the co-contributory influences of socio-economic indicators on access to SARS-CoV-2 testing and cumulative incidence, thus reflecting that apparent incidence rates mirror access to testing and socioeconomic considerations rather than true disease epidemiology. These analyses demonstrate how WES provides valuable information to contextualise and interpret laboratory-based epidemiological data. Whilst it is useful to have these associations established for SARS-CoV-2, the implications beyond SARS-CoV-2 are legion for two reasons, namely that biases inherent in clinical surveillance are broadly applicable across pathogens and all pathogens infecting humans will find their way into wastewater albeit in varying quantities. WES should be implemented to strengthen surveillance systems, especially where economic inequalities limit interpretability of conventional surveillance data. |
| format | Article |
| id | doaj-art-adee125a13524edaadfb5b691f75de90 |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-adee125a13524edaadfb5b691f75de902025-08-20T01:51:26ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01202e031133210.1371/journal.pone.0311332Wastewater surveillance overcomes socio-economic limitations of laboratory-based surveillance when monitoring disease transmission: The South African experience during the COVID-19 pandemic.Gillian MareeFiona ElsYashena NaidooLaven NaidooPhemelo MahamuzaMokgaetji MachekeNkosenhle NdlovuSaid RachidaChinwe Iwu-JajaSetshaba TaukobongSibonginkosi MaposaKathleen O'ReillyMukhlid YousifKerrigan McCarthyWastewater and environmental surveillance has been promoted as a communicable disease surveillance tool because it overcomes inherent biases in laboratory-based communicable disease surveillance. Yet, little empirical evidence exists to support this notion, and it remains largely an intuitive, though highly plausible hypothesis. Our interdisciplinary study uses WES data to show evidence for underreporting of SARS-CoV-2 in the context of measurable and statistically significant associations between economic conditions and SARS-CoV-2 incidence and testing rates. We obtained geolocated, anonymised, laboratory-confirmed SARS-CoV-2 cases, wastewater SARS-CoV-2 viral load data and socio-demographic data for Gauteng Province, South Africa. We spatially located all data to create a single dataset for sewershed catchments served by two large wastewater treatment plants. We conducted epidemiological, persons infected and principal component analysis to explore the relationships between variables. Overall, we demonstrate the co-contributory influences of socio-economic indicators on access to SARS-CoV-2 testing and cumulative incidence, thus reflecting that apparent incidence rates mirror access to testing and socioeconomic considerations rather than true disease epidemiology. These analyses demonstrate how WES provides valuable information to contextualise and interpret laboratory-based epidemiological data. Whilst it is useful to have these associations established for SARS-CoV-2, the implications beyond SARS-CoV-2 are legion for two reasons, namely that biases inherent in clinical surveillance are broadly applicable across pathogens and all pathogens infecting humans will find their way into wastewater albeit in varying quantities. WES should be implemented to strengthen surveillance systems, especially where economic inequalities limit interpretability of conventional surveillance data.https://doi.org/10.1371/journal.pone.0311332 |
| spellingShingle | Gillian Maree Fiona Els Yashena Naidoo Laven Naidoo Phemelo Mahamuza Mokgaetji Macheke Nkosenhle Ndlovu Said Rachida Chinwe Iwu-Jaja Setshaba Taukobong Sibonginkosi Maposa Kathleen O'Reilly Mukhlid Yousif Kerrigan McCarthy Wastewater surveillance overcomes socio-economic limitations of laboratory-based surveillance when monitoring disease transmission: The South African experience during the COVID-19 pandemic. PLoS ONE |
| title | Wastewater surveillance overcomes socio-economic limitations of laboratory-based surveillance when monitoring disease transmission: The South African experience during the COVID-19 pandemic. |
| title_full | Wastewater surveillance overcomes socio-economic limitations of laboratory-based surveillance when monitoring disease transmission: The South African experience during the COVID-19 pandemic. |
| title_fullStr | Wastewater surveillance overcomes socio-economic limitations of laboratory-based surveillance when monitoring disease transmission: The South African experience during the COVID-19 pandemic. |
| title_full_unstemmed | Wastewater surveillance overcomes socio-economic limitations of laboratory-based surveillance when monitoring disease transmission: The South African experience during the COVID-19 pandemic. |
| title_short | Wastewater surveillance overcomes socio-economic limitations of laboratory-based surveillance when monitoring disease transmission: The South African experience during the COVID-19 pandemic. |
| title_sort | wastewater surveillance overcomes socio economic limitations of laboratory based surveillance when monitoring disease transmission the south african experience during the covid 19 pandemic |
| url | https://doi.org/10.1371/journal.pone.0311332 |
| work_keys_str_mv | AT gillianmaree wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT fionaels wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT yashenanaidoo wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT lavennaidoo wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT phemelomahamuza wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT mokgaetjimacheke wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT nkosenhlendlovu wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT saidrachida wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT chinweiwujaja wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT setshabataukobong wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT sibonginkosimaposa wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT kathleenoreilly wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT mukhlidyousif wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic AT kerriganmccarthy wastewatersurveillanceovercomessocioeconomiclimitationsoflaboratorybasedsurveillancewhenmonitoringdiseasetransmissionthesouthafricanexperienceduringthecovid19pandemic |