Wastewater surveillance of SARS-CoV-2 and influenza in preK-12 schools shows school, community, and citywide infections

Madeline Wolken; Thomas Sun; Camille McCall; Rebecca Schneider; Kelsey Caton; Courtney Hundley; Loren Hopkins; Katherine Ensor; Kaavya Domakonda; Prashant Kalvapalle; David Persse; Stephen Williams; Lauren B Stadler

doi:10.1016/j.watres.2023.119648

Wastewater surveillance of SARS-CoV-2 and influenza in preK-12 schools shows school, community, and citywide infections

Water Res. 2023 Mar 1:231:119648. doi: 10.1016/j.watres.2023.119648. Epub 2023 Jan 20.

Authors

Affiliations

¹ Department of Civil and Environmental Engineering, Rice University, 6100 Main Street MS-519, Houston, TX, USA; Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center, 1200 Pressler Street, Houston, TX, USA.
² Department of Statistics, Rice University, 6100 Main Street MS 138, Houston, TX, USA.
³ Department of Civil and Environmental Engineering, Rice University, 6100 Main Street MS-519, Houston, TX, USA.
⁴ Houston Health Department, 8000 N. Stadium Dr., Houston, TX, USA.
⁵ Department of Statistics, Rice University, 6100 Main Street MS 138, Houston, TX, USA; Houston Health Department, 8000 N. Stadium Dr., Houston, TX, USA.
⁶ Systems, Synthetic, and Physical Biology, Rice University, Houston, TX, USA.
⁷ Houston Health Department, 8000 N. Stadium Dr., Houston, TX, USA; Department of Medicine and Surgery, Baylor College of Medicine, Houston, TX, USA; City of Houston Emergency Medical Services, Houston, TX, USA.
⁸ Department of Civil and Environmental Engineering, Rice University, 6100 Main Street MS-519, Houston, TX, USA. Electronic address: lauren.stadler@rice.edu.

Abstract

Wastewater surveillance is a passive and efficient way to monitor the spread of infectious diseases in large populations and high transmission areas such as preK-12 schools. Infections caused by respiratory viruses in school-aged children are likely underreported, particularly because many children may be asymptomatic or mildly symptomatic. Wastewater monitoring of SARS-CoV-2 has been studied extensively and primarily by sampling at centralized wastewater treatment plants, and there are limited studies on SARS-CoV-2 in preK-12 school wastewater. Similarly, wastewater detections of influenza have only been reported in wastewater treatment plant and university manhole samples. Here, we present the results of a 17-month wastewater monitoring program for SARS-CoV-2 (n = 2176 samples) and influenza A and B (n = 1217 samples) in 51 preK-12 schools. We show that school wastewater concentrations of SARS-CoV-2 RNA were strongly associated with COVID-19 cases in schools and community positivity rates, and that influenza detections in school wastewater were significantly associated with citywide influenza diagnosis rates. Results were communicated back to schools and local communities to enable mitigation strategies to stop the spread, and direct resources such as testing and vaccination clinics. This study demonstrates that school wastewater surveillance is reflective of local infections at several population levels and plays a crucial role in the detection and mitigation of outbreaks.

Keywords: COVID-19; Influenza; SARS-CoV-2; Wastewater-based epidemiology; preK-12 schools.

MeSH terms

COVID-19* / epidemiology
Child
Humans
Influenza, Human* / epidemiology
RNA, Viral
SARS-CoV-2
Wastewater
Wastewater-Based Epidemiological Monitoring

Substances

Wastewater
RNA, Viral