Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation.
Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation.
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DOI：
10.2196/44657
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发表时间：
2023-08-29
影响因子：
8.5
通讯作者：
Berry, Scott M.
中科院分区：
文献类型：
--
作者：
Keck, James W.;Lindner, Jess;Liversedge, Matthew;Mijatovic, Blazan;Olsson, Cullen;Strike, William;Noble, Anni;Adatorwovor, Reuben;Lacy, Parker;Smith, Ted;Berry, Scott M.
关键词：
废水监测为美国城市提供了COVID-19的早期迹象。在COVID-19大流行早期，长期护理机构（LTCF）的居民经历了不成比例的发病率和死亡率。我们在肯塔基州的6个设施实施了LTCF建筑水平的SARS-CoV-2废水监测，以在被认为是脆弱的人群中提供SARS-CoV-2的早期预警。本研究旨在评估肯塔基州LTCF对SARS-CoV-2废水监测的性能。我们进行了一个混合的方法评估废水监测以下疾病控制和预防中心（CDC）的指导方针，以评估公共卫生监测系统。疾病预防控制中心指南中的评估步骤包括让利益相关者参与，描述监测系统，重点关注评估设计，收集可信证据，并得出结论和建议。我们有目的地招募利益相关者进行半结构化访谈，并对访谈数据进行主题内容分析。我们整合了废水、临床检测和过程数据，以表征或计算7个监测系统性能属性（简单性、灵活性、数据质量、灵敏度和阳性预测值[PPV]、及时性、代表性和稳定性）。我们进行了8次访谈。该监测系统于2021年3月至2022年2月期间在肯塔基州的6个LTCF每周收集2至4次废水样本（N=811）。可信的证据表明，可变的监测性能的综合。关于简单性，监测的实施需要适度的人力资源和技术能力。关于灵活性，该系统有效地调整了监测频率，并证明了检测其他感兴趣病原体的能力。关于数据质量，软件识别了废水样本元数据输入中的错误（110/3120，占字段的3.53%），技术人员识别了聚合酶链反应数据问题（140/7734，占反应的1.81%），工作人员将所有数据更正输入日志。关于灵敏度和PPV，使用常规LTCF SARS-CoV-2临床检测结果作为金标准，对于LTCF的阳性临床检测，废水SARS-CoV-2信号>0 RNA拷贝/mL的灵敏度为30.6%（95% CI 24.4%-36.8%），特异性为79.7%（95% CI 76.4%-82.9%）。废水信号的PPV在>0 RNA拷贝/mL时为34.8%（95%CI 27.9%-41.7%），在>250拷贝/mL时增加至75%（95%CI 60%-90%）。关于及时性，利益相关者在样本采集后24至72小时收到监测数据，由于周末实验室工作人员缺乏，报告延迟。关于代表性，利益攸关方指出，由于游客、未知的工作人员饮酒习惯以及一些居民使用成人内裤防止其废物进入下水道系统，在界定造成LTCF废水的人口方面存在挑战。关于稳定性，在1个设施进行1天废水监测的重复成本约为144.50美元，包括运输、劳动力和材料费用。根据CDC标准，LTCF废水监测系统表现出混合性能。利益攸关方认为监测是可行的，并对其潜力表示乐观，同时也认识到在解释监测数据和就监测数据采取行动方面的挑战。
Wastewater surveillance provided early indication of COVID-19 in US municipalities. Residents of long-term care facilities (LTCFs) experienced disproportionate morbidity and mortality early in the COVID-19 pandemic. We implemented LTCF building-level wastewater surveillance for SARS-CoV-2 at 6 facilities in Kentucky to provide early warning of SARS-CoV-2 in populations considered vulnerable. This study aims to evaluate the performance of wastewater surveillance for SARS-CoV-2 at LTCFs in Kentucky. We conducted a mixed methods evaluation of wastewater surveillance following Centers for Disease Control and Prevention (CDC) guidelines for evaluating public health surveillance systems. Evaluation steps in the CDC guidelines were engaging stakeholders, describing the surveillance system, focusing the evaluation design, gathering credible evidence, and generating conclusions and recommendations. We purposively recruited stakeholders for semistructured interviews and undertook thematic content analysis of interview data. We integrated wastewater, clinical testing, and process data to characterize or calculate 7 surveillance system performance attributes (simplicity, flexibility, data quality, sensitivity and positive predictive value [PPV], timeliness, representativeness, and stability). We conducted 8 stakeholder interviews. The surveillance system collected wastewater samples (N=811) 2 to 4 times weekly at 6 LTCFs in Kentucky from March 2021 to February 2022. Synthesis of credible evidence indicated variable surveillance performance. Regarding simplicity, surveillance implementation required moderate human resource and technical capacity. Regarding flexibility, the system efficiently adjusted surveillance frequency and demonstrated the ability to detect additional pathogens of interest. Regarding data quality, software identified errors in wastewater sample metadata entry (110/3120, 3.53% of fields), technicians identified polymerase chain reaction data issues (140/7734, 1.81% of reactions), and staff entered all data corrections into a log. Regarding sensitivity and PPV, using routine LTCF SARS-CoV-2 clinical testing results as the gold standard, a wastewater SARS-CoV-2 signal of >0 RNA copies/mL was 30.6% (95% CI 24.4%-36.8%) sensitive and 79.7% (95% CI 76.4%-82.9%) specific for a positive clinical test at the LTCF. The PPV of the wastewater signal was 34.8% (95% CI 27.9%-41.7%) at >0 RNA copies/mL and increased to 75% (95% CI 60%-90%) at >250 copies/mL. Regarding timeliness, stakeholders received surveillance data 24 to 72 hours after sample collection, with delayed reporting because of the lack of weekend laboratory staff. Regarding representativeness, stakeholders identified challenges delineating the population contributing to LTCF wastewater because of visitors, unknown staff toileting habits, and the use of adult briefs by some residents preventing their waste from entering the sewer system. Regarding stability, the reoccurring cost to conduct 1 day of wastewater surveillance at 1 facility was approximately US $144.50, which included transportation, labor, and materials expenses. The LTCF wastewater surveillance system demonstrated mixed performance per CDC criteria. Stakeholders found surveillance feasible and expressed optimism regarding its potential while also recognizing challenges in interpreting and acting on surveillance data.
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