Wastewater monitoring for virus infections within communities can complement conventional clinical surveillance. Currently, most SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) clinical testing is voluntary and inconsistently available, except for a few occupational and educational settings, and therefore likely underrepresents actual population prevalence. Randomized testing on a regular basis to estimate accurate population-level infection rates is prohibitively costly and is hampered by a range of limitations and barriers associated with participation in clinical research. In comparison, community-level fecal monitoring can be performed through wastewater surveillance to effectively surveil communities. However, epidemiologically defined protocols for wastewater sample site selection are lacking. Herein, we describe methods for developing a geographically resolved population-level wastewater sampling approach in Jefferson County, Kentucky, and present preliminary results. Utilizing this site selection protocol, samples (n = 237) were collected from 17 wastewater catchment areas, September 8 to October 30, 2020 from one to four times per week in each area and compared to concurrent clinical data aggregated to wastewater catchment areas and county level. SARS-CoV-2 RNA was consistently present in wastewater during the studied period, and varied by area. Data obtained using the site selection protocol showed variation in geographically resolved wastewater SARS-CoV-2 RNA concentration compared to clinical rates. These findings highlight the importance of neighborhood-equivalent spatial scales and provide a promising approach for viral epidemic surveillance, thus better guiding spatially targeted public health mitigation strategies.

中文翻译：

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选择废水采样点来估计地理上解析的社区 COVID-19 流行率：采样协议的角度

社区内病毒感染的废水监测可以补充传统的临床监测。目前，除少数职业和教育环境外，大多数 SARS-CoV-2（严重急性呼吸综合征冠状病毒 2）临床检测都是自愿进行的，并且可用性不一致，因此可能低估了实际人群的患病率。定期进行随机测试来估计准确的人群感染率的成本高昂，并且受到与参与临床研究相关的一系列限制和障碍的阻碍。相比之下，社区层面的粪便监测可以通过废水监测来进行，从而有效地监测社区。然而，缺乏流行病学定义的废水样本地点选择方案。在此，我们描述了在肯塔基州杰斐逊县开发地理分辨率的人口水平废水采样方法的方法，并提出了初步结果。利用该选址方案，从 2020 年 9 月 8 日至 10 月 30 日从 17 个废水集水区收集样本（n  = 237），每个区域每周收集一到四次，并与废水集水区和县汇总的并发临床数据进行比较等级。在研究期间，SARS-CoV-2 RNA 始终存在于废水中，但因地区而异。使用选址方案获得的数据显示，与临床比率相比，地理分辨废水 SARS-CoV-2 RNA 浓度存在差异。这些发现强调了邻里等效空间尺度的重要性，并为病毒流行病监测提供了一种有前景的方法，从而更好地指导空间针对性的公共卫生缓解策略。