A-Z Index × Submit A-Z Index × Submit A-Z Index Search Dropdown × Submit Facebook Twitter LinkedIn Syndicate Emerging Infectious Disease journal ISSN: 1080-6059 Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
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Wastewater surveillance (WS) is underused in rural communities. We evaluated WS performance in the remote, subarctic, mostly Indigenous, community of Bethel, Alaska, USA, during October 2022–May 2024. Wastewater was collected > 3 times weekly and underwent on-site PCR testing for SARS-CoV-2, respiratory syncytial virus (RSV), and influenza A and B viruses. We compared WS virus detection with local clinical data by using results from 318 wastewater samples and 7,392 clinical tests. We detected SARS-CoV-2 in 265 (83.3%) wastewater samples, influenza A virus in 128 (40.3%), RSV in 78 (24.5%), and influenza B virus in 29 (9.1%). Wastewater signals correlated with clinical results for influenza B virus (Spearman ρ = 0.85), influenza A virus (ρ = 0.62), RSV (ρ = 0.60), and SARS-CoV-2 (ρ = 0.59), providing corroborating data that informed the timing of seasonal respiratory virus immunization campaigns. Our findings show that WS is feasible and useful for disease surveillance in rural Alaska.
Wastewater surveillance (WS) expanded substantially during the COVID-19 pandemic ( 1 ). Testing wastewater for the SARS-CoV-2 virus has several advantages over traditional case-based disease surveillance, including its efficiency in monitoring community disease trends, independence from healthcare-seeking behaviors that inform traditional surveillance approaches, and scalability from building-level monitoring to sewersheds serving millions of persons ( 2 ). WS has yielded actionable COVID-19 public health information across a variety of settings ( 3 ). Subsequently, WS platforms have expanded to include additional respiratory viruses, such as respiratory syncytial virus (RSV) and influenza virus ( 4 ), and have supported public health responses during respiratory virus seasons ( 5 ).
Smaller and remote communities have had lower uptake of WS ( 6 ). Barriers to adoption in rural and remote areas include limited access to wastewater testing laboratories, costs, insufficient human resources, lack of centralized wastewater collection and treatment systems, and competing priorities ( 7 ). Local implementation of WS could overcome the high cost and logistical challenges of shipping samples to third-party laboratories, thus improving the timeliness of wastewater data ( 8 ). Early in the COVID-19 pandemic, a team from Canada demonstrated the feasibility and accuracy of using a rapid and user-friendly clinical PCR platform to measure SARS-CoV-2 virus levels on site in a remote community ( 9 ). Their WS pilot uncovered previously unknown COVID-19 infections in the community and initiated a public health response. The reported effectiveness and relative simplicity of the WS approach used by Canada team informed the implementation of WS in a remote community in Alaska, USA.
Rural Alaska is home to hundreds of mostly Indigenous communities located off the road system, relying on water and air transportation for travel. Historic inequities and socio-environmental conditions, such as lack of in-home piped water and household crowding, have contributed to high rates of respiratory virus infe…