Monitoring human arboviral diseases through wastewater surveillance: Challenges, progress and future opportunities

• Published in: Water research (Oxford) 2022-09, Vol.223, p.118904-118904, Article 118904
• Main Authors: Lee, Wei Lin, Gu, Xiaoqiong, Armas, Federica, Leifels, Mats, Wu, Fuqing, Chandra, Franciscus, Chua, Feng Jun Desmond, Syenina, Ayesa, Chen, Hongjie, Cheng, Dan, Ooi, Eng Eong, Wuertz, Stefan, Alm, Eric J, Thompson, Janelle
• Format: Article
• Language: English
• Subjects: Arbovirus; Dengue; Flavivirus; Wastewater surveillance; WBE; WBS; Zika
• ISSN: 0043-1354; 1879-2448
• DOI: 10.1016/j.watres.2022.118904

•Gaps exist in current modes of arboviral disease surveillance.•Arboviruses are shed in urine of infected individuals.•Wastewater-based surveillance may be utilized for monitoring arboviral diseases.•Successful implementation warrants development of methods optimized for arboviruses. Arboviral diseases are caused by a group of viruses spread by the bite of infected arthropods. Amongst these, dengue, Zika, west nile fever and yellow fever cause the greatest economic and social impact. Arboviral epidemics have increased in frequency, magnitude and geographical extent over the past decades and are expected to continue increasing with climate change and expanding urbanisation. Arboviral prevalence is largely underestimated, as most infections are asymptomatic, nevertheless existing surveillance systems are based on passive reporting of loosely defined clinical syndromes with infrequent laboratory confirmation. Wastewater-based surveillance (WBS), which has been demonstrated to be useful for monitoring diseases with significant asymptomatic populations including COVID19 and polio, could be a useful complement to arboviral surveillance. We review the current state of knowledge and identify key factors that affect the feasibility of monitoring arboviral diseases by WBS to include viral shedding loads by infected persons, the persistence of shed arboviruses and the efficiency of their recovery from sewage. We provide a simple model on the volume of wastewater that needs to be processed for detection of arboviruses, in face of lower arboviral shedding rates. In all, this review serves to reflect on the key challenges that need to be addressed and overcome for successful implementation of arboviral WBS. Wastewater-based surveillance as a complement to clinical surveillance for collective monitoring of symptomatic and asymptomatic infections. Arboviruses have a complex transmission cycle consisting of a sylvatic cycle where they circulate between animals and mosquitoes, and a human cycle where they circulate between humans and mosquitoes. Clinical surveillance is the main pillar of arboviral surveillance, however it is mostly made up of symptomatic cases which seek medical attention, and those who are subsequently accurately diagnosed to carry arboviral infections. Wastewater is an aggregate collection of all individuals within the catchment, potentially sampling both symptomatic and asymptomatic populations, and WBS would be a useful complement for arboviral disease