The same sewage surveillance techniques that have become a critical tool in early detection of COVID-19 outbreaks are being adapted to monitor the alarming spread of monkeypox in the San Francisco Bay Area and beyond. other US communities
Before the Covid pandemic, sewage sludge was thought to hold promise as an early indicator of health threats, in part because people can excrete genetic evidence of infectious diseases in their stool, often before they develop symptoms. of illness
Israel has for decades monitored sewage for polio. But before covid, in the United States that risk control was almost exclusively limited to academic activities.
Since covid, a research alliance with scientists from Stanford University, Michigan and Emory pioneered efforts to recalibrate surveillance techniques to detect the covid-19 virus — the first time sewage has been used to track a respiratory disease.
That same team, the Sewer Coronavirus Alert Network, or SCAN, is now a leader in expanding sewage monitoring for monkeypox, a virus endemic to remote parts of Africa that within months it has infected more than 26,000 people worldwide, and more than 7,000 in the country.
A few days ago, the Biden administration declared the monkeypox outbreak a public health emergency, after it was declared in California, Illinois and New York.
And SCAN scientists envision a future in which sewage sludge is used to track threatening public health problems. “We’re looking at a wide range of things that we could test for,” said Marlene Wolfe, an assistant professor of environmental health at Emory.
Since expanding its surveillance in mid-June, the SCAN team has detected monkeypox in several of the 11 Northern California sewer basins it is monitoring, including Palo Alto, San Jose, Gilroy, Sacramento and two locations in San Francisco.
Funded by grants from the National Science Foundation and the CDC Foundation, SCAN is conducting similar monitoring in Colorado, Georgia, Michigan and four other states and is looking to expand to up to 300 sites.
It is one of a growing number of wastewater monitoring projects run jointly by universities, public health agencies and utility departments that are reporting Covid findings to state and federal agencies.
SCAN sites in California, Georgia, Michigan and Texas, and a research team in Nevada are among the few that reported samples that tested positive for monkeypox virus.
As with covid, monkeypox data can be used to compare trends across regions, but there are limits to what can be achieved. Wastewater monitoring does not identify who is doing it; it only reveals the presence of a virus in a given area. And a specialist is needed to analyze the samples. The researchers believe that wastewater surveillance is a complement to other public health tools, not a replacement.
“We’re still on the cutting edge in terms of uncovering the potential,” said Heather Bischel, an assistant professor of civil and environmental engineering at the University of California-Davis. “But what we’ve already seen shows that this type of monitoring is adaptable to other public health threats.”
Some communities already took wastewater samples before the pandemic to find out what kinds of opioids residents were using. More recently, the technology has also shown promise for monitoring influenza and respiratory syncytial virus (RSV). The Centers for Disease Control and Prevention (CDC) is planning pilot studies to see if wastewater can reveal trends in antibiotic-resistant infections, foodborne infections, and candida auris, a fungal infection.
Much of the wastewater testing relied on funding provided through federal covid relief legislation. At the Bischel campus, those funds were combined with money from university donors to put together a comprehensive test and treatment for the school and the city of Davis that dismantled sewage policing. Wastewater testing is ongoing under a separate grant.
Currently, the CDC only reports Covid results in its national sewage surveillance system, a reflection of the limited number of sewer basins so far being tested for monkeypox.
The global spread of monkeypox was first detected in the UK in May and it was thought that this virus could also pass into sewage, either through faeces or when a person became infected with an open sore. showering
Sewers in areas with infected people could “light up” with evidence of the disease, if sewage tests could identify it.
“And it lit up,” said Brad Pollock, chair of public health sciences at UC Davis Health. “It acts as a warning system and you don’t have to persuade people to take individual tests in order to use the information; it’s passively collected, so you get a broader look at that community.”
The virus is thought to spread primarily through intimate skin-to-skin contact and exposure to symptomatic lesions, although researchers are exploring other routes of transmission. For now, the outbreak here is mostly concentrated among men who have sex with men.
The discovery of monkeypox in San Francisco’s sewage system in June, the first such finding in the country, raised alarm in a city with a growing LGBTQ+ population. On July 28, San Francisco declared monkeypox a public health emergency and urged the federal government to step up vaccine distribution.
For surveillance in Northern California, SCAN partners with local health officials and universities to collect samples, which it sends to Verily Life Sciences, a health technology company owned by Google parent company Alphabet, for testing. In the Atlanta area, SCAN is working with health officials in Emory and Fulton counties.
But not all public health agencies are moving so fast. A sewage monitoring plan for the virus is only now being developed in Los Angeles County, which had confirmed more than 300 cases of monkeypox by the end of July.
“With every new thing we add to the test platform, we’re learning things,” said SCAN’s Wolfe. “The pandemic really opened up our imagination for a tool that already existed but hadn’t been developed to its full potential. That is now changing.”
KHN (Kaiser Health News) is the newsroom of KFF (Kaiser Family Foundation), which produces in-depth health journalism. It is one of three major programs of KFF, a nonprofit organization that analyzes the nation’s health and public health issues.