This study aimed to develop a framework for combining community wastewater surveillance with state clinical surveillance for the confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants within the community and to provide recommendations on how to expand on such research and apply the findings in public health responses. Wastewater samples were collected weekly from 17 geographically resolved locations in Louisville/Jefferson County, Kentucky (USA), from February 10 to December 13, 2021. Genomic surveillance and quantitative reverse transcription PCR (RT-qPCR) platforms were used to screen for SARS-CoV-2 in wastewater, and state clinical surveillance was used for confirmation. The study results highlighted an increased epidemiological value of combining community wastewater genomic surveillance and RT-qPCR with conventional case-auditing methods. The spatial scale and temporal frequency of wastewater sampling provided promising sensitivity and specificity for gaining public health screening insights about SARS-CoV-2 emergence, seeding, and spread in communities. Improved national surveillance systems are needed against future pathogens and variants, and wastewater-based genomic surveillance exhibits great potential when coupled with clinical testing. This paper presents evidence that complementary wastewater and clinical testing are cost-effectively enhanced when used in combination, as they provide a strong tool for a joint public health framework. Future pathogens of interest may be examined in either a targeted fashion or using a more global approach where all pathogens are monitored. This study has also provided novel insights developed from evidence-based public health practices.

本研究旨在开发一个框架，将社区废水监测与国家临床监测相结合，以确认社区内严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 变种，并就如何扩展此类研究和应用提供建议公共卫生应对措施中的发现。 2021 年 2 月 10 日至 12 月 13 日，每周从美国肯塔基州路易斯维尔/杰斐逊县的 17 个地理定位地点收集废水样本。基因组监测和定量逆转录 PCR (RT-qPCR) 平台用于筛查 SARS-废水中存在 CoV-2，并使用国家临床监测进行确认。研究结果强调了将社区废水基因组监测和 RT-qPCR 与传统病例审核方法相结合的流行病学价值。废水采样的空间规模和时间频率为获得有关 SARS-CoV-2 在社区中出现、播种和传播的公共卫生筛查见解提供了良好的灵敏度和特异性。需要针对未来的病原体和变种改进国家监测系统，基于废水的基因组监测与临床测试相结合显示出巨大的潜力。本文提出的证据表明，互补废水和临床检测结合使用时可以提高成本效益，因为它们为联合公共卫生框架提供了强有力的工具。未来感兴趣的病原体可能会以有针对性的方式进行检查，或者使用更全面的方法来监测所有病原体。这项研究还提供了从循证公共卫生实践中得出的新颖见解。