Wastewater-Based Epidemiology: Wastewater Surveillance for Pandemic Preparedness

污水监测(WWS)作为一种聚集的、匿名的、非侵入性的社区疾病测量手段，已经应用了几十年。自2019年冠状病毒病(新冠肺炎)爆发以来，导致新冠肺炎的严重急性呼吸综合征2型病毒(SARS-CoV-2)的WWS已经出现并扩展到57多个国家。在扩大CoV-2 WWS的同时，我们对WWS的用途和好处的了解也在加速推进；WWS显示出有可能在小人口和大人口中及早发现暴发、复发和下一波疾病。G7大流行防备伙伴关系最近强调需要“一个反应迅速的诊断部门[.]大规模生产准确和快速的诊断测试，以便及早发现新病例”。因此，WWS被定位为一种很有前途的技术，不仅适用于加拿大的大流行预防，也适用于其他国家。要将WWS的承诺转化为预防大流行的实用响应诊断工具，关键是继续发展我们对WWS测量的理解和解释。特别是，世界卫生组织、美国疾病控制和预防中心、加拿大公共卫生局、学术研究人员和其他机构已经确定有必要进一步了解和最大限度地减少与WWS测量相关的变异性和不确定性。拟议的研究计划旨在促进我们对下水道中疾病基因靶标的命运和运输的理解，并开发数据标准化策略，以提高WWS用于疾病估计的准确性和可靠性。拟议研究计划的科学方法是进行实验室规模的受控实验，以隔离与下水道运输和下水道冲刷事件(包括暴雨和融雪事件)相关的CoV-2 RNA的持久性或降解。实验室规模的实验将通过具体的全尺寸下水道系统测试来补充，以将在实验室规模获得的新知识转化为全尺寸系统。随后，研究计划将应用归一化策略来确定这些策略的潜力，以最大限度地减少下水道运输和冲洗事件引起的变异性，并最终提高CoV-2 WWS测量报告和解释的精确度和准确性。该研究计划将解决CoV-2基因靶标的测量问题，其结果可转移到未来大流行的重要疾病靶标。拟议的研究计划将把废水从废物来源发展为社区健康的替代品，并将推动加拿大和国际上公共卫生保护和大流行预防的快速诊断技术的发展。

Wastewater surveillance (WWS) has been applied for several decades as an aggregated, anonymous, and non-invasive measurement of community disease. Since the onset of the coronavirus disease in 2019 (COVID-19), WWS of the severe acute respiratory syndrome-2 virus (SARS-CoV-2), virus responsible for COVID-19, has emerged and expanded to over 57 countries. The expansion of CoV-2 WWS has been paralleled with an accelerated advancement in our understanding of the uses and benefits of WWS; with WWS demonstrating the potential to identify early detection of outbreaks, resurgences and next waves of disease in both small and large populations. The G7 Pandemic Preparedness Partnership recently highlighted the need for "a responsive diagnostics sector [.] producing accurate and rapid diagnostic tests at scale to detect new cases early". As such, WWS is positioned as a promising technology for not only pandemic preparedness in Canada but also for other countries. To translate the promise of WWS into an applied responsive diagnostic tool for pandemic preparedness, it is critical to continue to develop our understanding and interpretation of WWS measurements. In particular, the World Health Organization, the US Centers for Disease Control and Prevention, the Public Health Agency of Canada, academic researchers and others have identified the need to further understand and minimize variability and uncertainty associated with WWS measurements. The proposed research program aims to advance our understanding of the fate and transport of disease gene targets in sewers and to develop data normalization strategies to improve the accuracy and reliability of WWS for disease estimation. The scientific approach of the proposed research program is to perform controlled, laboratory-scale experiments to isolate the persistence or degradation associated with CoV-2 RNA during sewer transport and sewer flushing events, including heavy rainfall and snow melt events. The laboratory-scale experiments will be complimented by specific full-scale sewer system testing to translate the new knowledge attained at laboratory-scale to full-scale systems. Successively, the research program will apply normalization strategies to determine the potential of these strategies to minimize the variability induced by sewer transport and flushing events and to ultimately improve the precision and accuracy in the reporting and interpretation of CoV-2 WWS measurements. The research program will address CoV-2 gene target measurements with the findings being transferrable to important disease targets of future pandemics. The proposed research program will evolve the current perspective of wastewater from a source of waste to a proxy of community health and will advance the development of a rapid diagnostic technology for public health protection and pandemic preparedness in Canada and internationally.