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Wastewater-based epidemiology

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Wastewater-based epidemiology (or wastewater-based surveillance or sewage chemical-information mining) analyzes wastewater to determine the consumption of, or exposure to, chemicals or pathogens in a population. This is achieved by measuring chemical or biomarkers in wastewater generated by the people contributing to a sewage treatment plant catchment.[1] Wastewater-based epidemiology has been used to estimate illicit drug use in communities or populations, but can be used to measure the consumption of alcohol, caffeine, various pharmaceuticals and other compounds.[2] Wastewater-based epidemiology has also been adapted to measure the load of pathogens such as SARS-CoV-2 in a community.[3] It differs from traditional drug testing, urine or stool testing in that results are population-level rather than individual level. Wastewater-based epidemiology is an interdisciplinary endeavour that draws on input from specialists such as wastewater treatment plant operators, analytical chemists and epidemiologists.

History

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Wastewater-based epidemiology (WBE) can be applied in the field of research that uses the analysis of sewage and wastewater to monitor the presence, distribution, and prevalence of a disease or chemicals in communities. The technique has been used for several decades, and an example of its early application is in the 1940s when WBE was applied for the detection and distribution of poliovirus in the sewage of New York, Chicago, and other cities.[4] Another early application came in 1954, in a study of schistosome of snails.[5] Wastewater-based epidemiology thereafter spread to multiple countries. By the turn of the 21st century, numerous studies had adopted the technique.[6] A 2005 study measured cocaine and its metabolite benzoylecgonine in water samples from the River Po in Italy.[7]

Wastewater-based epidemiology is supported by government bodies such as the European Monitoring Centre for Drugs and Drug Addiction in Europe.[8] Similar counterparts in other countries, such as the Australian Criminal Intelligence Commission in Australia[9] and authorities in China[10] use wastewater-based epidemiology to monitor drug use in their populations.

As of 2022, WBE had reached 3,000 sites in 58 countries.[11]

A group of Chinese scientists published the first WBE study on SARS-CoV-2 in 2020. They assessed whether the virus was present in fecal samples among 74 patients hospitalized for COVID-19 between January 16 and March 15, 2020, at a Chinese hospital. The first US SARS-CoV-2 study came from Boston. It reported a far higher rate of infection than had been estimated from individual PCR testing. It also served as a warning system, alerting the public to outbreaks (and outbreak ends) before positive test rates changed. However, considerable variability has been found within populations, based on symptom profiles, which may compromise measurement accuracy as the pathogen evolves.[12]

Technique

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Wastewater-based epidemiology is analogous to urinalysis on a community scale. Small molecule compounds consumed by an individual can be excreted in the urine and/or feces in the form of the unchanged parent compound or a metabolite. In communities with sewerage, this urine combines with other wastes including other individuals' urine as they travel to a municipal wastewater treatment plant. The wastewater is sampled at the plant's inlet, prior to treatment. This is typically done with autosampler devices that collect 24-hour flow or temporally composite samples. These samples contain biomarkers from all the people contributing to a catchment.[13] Collected samples are sent to a laboratory, where analytical chemistry techniques (such as liquid chromatography-mass spectrometry) are used to quantify compounds of interest. These results can be expressed in per capita loads based on the volume of wastewater.[14] Per capita daily consumption of a chemical of interest (e.g. a drug) is determined as

where R is the concentration of a residue in a wastewater sample, F is the volume of wastewater that the sample represents, C is a correction factor which reflects the average mass and molar excretion fraction of a parent drug or a metabolite, and P is the number of people in a wastewater catchment. Variations or modifications may be made to C to account for other factors such as the degradation of a chemical during its transport in the sewer system.[2]

Applications

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Commonly detected chemicals include, but are not limited to the following;[13][2]

Temporal comparisons

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By analyzing samples taken across different time points, day-to-day or longer-term trends can be assessed. This approach has illustrated trends such as increased consumption of alcohol and recreational drugs on weekends compared to weekdays.[13] A temporal wastewater-based epidemiology study in Washington measured wastewater samples in Washington before, during and after cannabis legalisation. By comparing cannabis consumption in wastewater with sales of cannabis through legal outlets, the study showed that the opening of legal outlets led to a decrease in the market share of the illegal market.[15]

Spatial comparisons

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Differences in chemical consumption amongst different locations can be established when comparable methods are used to analyse wastewater samples from different locations. The European Monitoring Centre for Drugs and Drug Addiction conducts regular multi-city tests in Europe to estimate the consumption of illegal drugs. Data from these monitoring efforts are used alongside more traditional monitoring methods to understand geographical changes in drug consumption trends.[8]

Microbial surveillance

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Virus surveillance

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Sewage can also be tested for signatures of viruses excreted via feces, such as the enteroviruses poliovirus, aichivirus and coronavirus.[16][17][3] Systematic wastewater surveillance programs for monitoring enteroviruses, namely poliovirus, were instituted as early as 1996 in Russia.[18] Wastewater testing is recognised as an important tool for poliovirus surveillance by the WHO, especially in situations where mainstream surveillance methods are lacking, or where viral circulation or introduction is suspected.[19] Wastewater-based epidemiology of viruses has the potential to inform on the presence of viral outbreaks when or where it is not suspected. A 2013 study of archived wastewater samples from the Netherlands found viral RNA of Aichivirus A in Dutch sewage samples dating back to 1987, two years prior to the first identification of Aichivirus A in Japan.[20] During the COVID-19 pandemic, wastewater-based epidemiology using qPCR and/or RNA-Seq was used in various countries as a complementary method for assessing the load of COVID-19 and its variants in populations.[3][21][22] Regular surveillance programs for monitoring SARS-Cov-2 in wastewater has been instituted in populations within countries such as Canada, UAE,[23] China, Singapore, the Netherlands,[24] Spain,[25] Austria,[22] Germany[26] and the United States.[27] In addition to surveillance of human wastewater, studies have also been conducted on livestock wastewater.[28] A 2011 article reported findings of 11.8% of collected human wastewater samples and 8.6% of swine wastewater samples as positive of the pathogen Clostridiodes Difficile.[29]

Applications against major outbreaks

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See also: Pandemic prevention § Testing and containment, and Pandemic prevention § Mutation surveillance
This section is an excerpt from COVID-19 testing § Surveillance and screening of populations.[edit]
As of August 2020, the WHO recognizes wastewater surveillance of SARS-CoV-2 as a potentially useful source of information on the prevalence and temporal trends of COVID-19 in communities, while highlighting that gaps in research such as viral shedding characteristics should be addressed.[30] Such aggregative testing may have detected early cases.[31] Studies show that wastewater-based epidemiology has the potential for an early warning system and monitoring for COVID-19 infections.[32][33][34][35][36] This may prove particularly useful once large shares of regional populations are vaccinated or recovered and do not need to conduct rapid tests while in some cases being infectious nevertheless.[37]
Rough workflow of detection of monkeypox virus DNA in wastewater samples in the Netherlands[38]

Wastewater surveillance, which substantially expanded during the earlier COVID-19 pandemic was used to detect monkeypox in the 2022 monkeypox outbreak.[39][40][38]

It is unclear how cost-effective wastewater surveillance is, but national coordination and standardized methods could be useful.[41] Less common infections may be difficult to detect, including, such as those that cause hepatitis or foodborne illness.[42] A warning of increased cases from wastewater surveillance can "provide health departments with critical lead time for making decisions about resource allocation and preventive measures" and "unlike testing of individual people, wastewater testing provides insights into the entire population within a catchment area".[43]

A 2023 report by the National Academies of Sciences, Engineering and Medicine called for moving from the grass roots system that "sprung up in an ad hoc way, fueled by volunteerism and emergency pandemic-related funding" to a more standardized national system and suggested such a system "should be able to track a variety of potential threats, which could include future coronavirus variants, flu viruses, antibiotic resistant bacteria and entirely new pathogens".[44]

Antimicrobial resistance

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The global 'resistome' based on sewage-based monitoring[45]
Gene-sharing network between bacterial genera[45]

In 2022, genomic epidemiologists reported results from a global survey of antimicrobial resistance (AMR) via genomic wastewater-based epidemiology, finding large regional variations, providing maps, and suggesting resistance genes are also passed on between microbial species that are not closely related.[46][45] A 2023 review on wastewater-based epidemiology opined the necessity of surveillance wastewater from farms with livestock, wet markets and surrounding areas given the greater risk of pathogen spillover to humans.[47]

See also

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References

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  1. ^ Sims, Natalie; Kasprzyk-Hordern, Barbara (2020). "Future perspectives of wastewater-based epidemiology: Monitoring infectious disease spread and resistance to the community level". Environment International. 139: 105689. doi:10.1016/j.envint.2020.105689. ISSN 0160-4120. PMC 7128895. PMID 32283358.
  2. ^ a b c Choi, Phil M.; Tscharke, Ben J.; Donner, Erica; O'Brien, Jake W.; Grant, Sharon C.; Kaserzon, Sarit L.; Mackie, Rachel; O'Malley, Elissa; Crosbie, Nicholas D.; Thomas, Kevin V.; Mueller, Jochen F. (2018). "Wastewater-based epidemiology biomarkers: Past, present and future". TrAC Trends in Analytical Chemistry. 105: 453–469. doi:10.1016/j.trac.2018.06.004. ISSN 0165-9936. S2CID 103979335.
  3. ^ a b c Medema, Gertjan; Heijnen, Leo; Elsinga, Goffe; Italiaander, Ronald; Brouwer, Anke (2020). "Presence of SARS-Coronavirus-2 RNA in Sewage and Correlation with Reported COVID-19 Prevalence in the Early Stage of the Epidemic in The Netherlands". Environmental Science & Technology Letters. 7 (7): 511–516. Bibcode:2020EnSTL...7..511M. doi:10.1021/acs.estlett.0c00357. ISSN 2328-8930. PMC 7254611. PMID 37566285.
  4. ^ Metcalf, T. G.; Melnick, J. L.; Estes, M. K. (October 1995). "ENVIRONMENTAL VIROLOGY: From Detection of Virus in Sewage and Water by Isolation to Identification by Molecular Biology—A Trip of Over 50 Years". Annual Review of Microbiology. 49 (1): 461–487. doi:10.1146/annurev.mi.49.100195.002333. ISSN 0066-4227. PMID 8561468.
  5. ^ Bayer, F. A. (July 1954). "Schistosome infection of snails in a dam traced to pollution with sewage". Transactions of the Royal Society of Tropical Medicine and Hygiene. 48 (4): 347–350. doi:10.1016/0035-9203(54)90108-x. ISSN 0035-9203. PMID 13187568.
  6. ^ Glassmeyer, Susan T.; Furlong, Edward T.; Kolpin, Dana W.; Cahill, Jeffery D.; Zaugg, Steven D.; Werner, Stephen L.; Meyer, Michael T.; Kryak, David D. (2005). "Transport of Chemical and Microbial Compounds from Known Wastewater Discharges: Potential for Use as Indicators of Human Fecal Contamination". Environmental Science & Technology. 39 (14): 5157–5169. Bibcode:2005EnST...39.5157G. doi:10.1021/es048120k. ISSN 0013-936X. PMID 16082943. S2CID 10305464.
  7. ^ Zuccato, E; Chiabrando, C; Castiglioni, S; Calamari, D; Bagnati, R; Schiarea, S; Fanelli, R (2005). "Cocaine in surface waters: a new evidence-based tool to monitor community drug abuse". Environmental Health. 4 (14): 14. Bibcode:2005EnvHe...4...14Z. doi:10.1186/1476-069X-4-14. PMC 1190203. PMID 16083497.
  8. ^ a b "Wastewater analysis and drugs: a European multi-city study" (PDF). European Monitoring Centre for Drugs and Drug Addiction. 12 March 2020. Archived from the original (PDF) on 17 November 2020. Retrieved 31 August 2020.
  9. ^ "National Wastewater Drug Monitoring Program reports". Australian Criminal Intelligence Commission. 30 June 2020. Archived from the original on 20 September 2020. Retrieved 2 July 2020.
  10. ^ Cryanoski, D. (16 July 2018). "China expands surveillance of sewage to police illegal drug use". Nature. 559 (7714): 310–311. Bibcode:2018Natur.559..310C. doi:10.1038/d41586-018-05728-3. PMID 30018440. S2CID 51677467.
  11. ^ "ArcGIS Dashboards: Summary of Global SARS-CoV-2 Wastewater Monitoring Efforts by UC Merced Researchers". www.arcgis.com. Retrieved 2022-02-09.
  12. ^ Jetelina, Katelyn (2022-02-09). "Wastewater: Taking surveillance to the next level". Your Local Epidemiologist. Retrieved 2022-02-09.
  13. ^ a b c Assessing illicit drugs in wastewater (PDF). Lisbon, Portugal: Publications Office of the European Union. 2016. pp. 1–82. ISBN 978-92-9168-856-2. Archived from the original (PDF) on 2020-11-06. Retrieved 2020-08-31. {{cite book}}: |website= ignored (help)
  14. ^ Gracia-Lor, Emma; Castiglioni, Sara; Bade, Richard; Been, Frederic; Castrignanò, Erika; Covaci, Adrian; González-Mariño, Iria; Hapeshi, Evroula; Kasprzyk-Hordern, Barbara; Kinyua, Juliet; Lai, Foon Yin; Letzel, Thomas; Lopardo, Luigi; Meyer, Markus R.; O'Brien, Jake; Ramin, Pedram; Rousis, Nikolaos I.; Rydevik, Axel; Ryu, Yeonsuk; Santos, Miguel M.; Senta, Ivan; Thomaidis, Nikolaos S.; Veloutsou, Sofia; Yang, Zhugen; Zuccato, Ettore; Bijlsma, Lubertus (2017). "Measuring biomarkers in wastewater as a new source of epidemiological information: Current state and future perspectives" (PDF). Environment International. 99: 131–150. doi:10.1016/j.envint.2016.12.016. hdl:10234/165745. ISSN 0160-4120. PMID 28038971. S2CID 207743034.
  15. ^ Burgard, Daniel A.; Williams, Jason; Westerman, Danielle; Rushing, Rosie; Carpenter, Riley; LaRock, Addison; Sadetsky, Jane; Clarke, Jackson; Fryhle, Heather; Pellman, Melissa; Banta-Green, Caleb J. (2019). "Using wastewater-based analysis to monitor the effects of legalized retail sales on cannabis consumption in Washington State, USA". Addiction. 114 (9): 1582–1590. doi:10.1111/add.14641. ISSN 0965-2140. PMC 6814135. PMID 31211480.
  16. ^ Okoh, Anthony I.; Sibanda, Thulani; Gusha, Siyabulela S. (2010). "Inadequately Treated Wastewater as a Source of Human Enteric Viruses in the Environment". International Journal of Environmental Research and Public Health. 7 (6): 2620–2637. doi:10.3390/ijerph7062620. ISSN 1660-4601. PMC 2905569. PMID 20644692.
  17. ^ Gundy, Patricia M.; Gerba, Charles P.; Pepper, Ian L. (2008). "Survival of Coronaviruses in Water and Wastewater". Food and Environmental Virology. 1 (1): 10. doi:10.1007/s12560-008-9001-6. ISSN 1867-0334. PMC 7091381.
  18. ^ Ivanova, Olga E.; Yarmolskaya, Maria S.; Eremeeva, Tatiana P.; Babkina, Galina M.; Baykova, Olga Y.; Akhmadishina, Lyudmila V.; Krasota, Alexandr Y.; Kozlovskaya, Liubov I.; Lukashev, Alexander N. (2019). "Environmental Surveillance for Poliovirus and Other Enteroviruses: Long-Term Experience in Moscow, Russian Federation, 2004–2017". Viruses. 11 (5): 424. doi:10.3390/v11050424. ISSN 1999-4915. PMC 6563241. PMID 31072058.
  19. ^ "Guidelines for environmental surveillance of poliovirus circulation" (PDF). WHO. 2003.
  20. ^ Lodder, Willemijn J.; Rutjes, Saskia A.; Takumi, Katsuhisa; Husman, Ana Maria de Roda (2013). "Aichi Virus in Sewage and Surface Water, the Netherlands". Emerging Infectious Diseases. 19 (8): 1222–1230. doi:10.3201/eid1908.130312. ISSN 1080-6040. PMC 3739534. PMID 23876456.
  21. ^ "Status of environmental surveillance for SARS-CoV-2 virus" (PDF). World Health Organisation. 5 August 2020. Retrieved 6 August 2020.
  22. ^ a b Amman, Fabian; Markt, Rudolf (2022). "Viral variant-resolved wastewater surveillance of SARS-CoV-2 at national scale". Nat Biotechnol. 40 (12): 1814–1822. doi:10.1038/s41587-022-01387-y. PMID 35851376. S2CID 250642091.
  23. ^ Hasan, Shadi W.; Ibrahim, Yazan; Daou, Marianne; Kannout, Hussein; Jan, Nila; Lopes, Alvaro; Alsafar, Habiba; Yousef, Ahmed F. (10 April 2021). "Detection and quantification of SARS-CoV-2 RNA in wastewater and treated effluents: Surveillance of COVID-19 epidemic in the United Arab Emirates". Science of the Total Environment. 764: 142929. Bibcode:2021ScTEn.76442929H. doi:10.1016/j.scitotenv.2020.142929. ISSN 0048-9697. PMC 7571379. PMID 33131867.
  24. ^ "Sewage research". National Institute for Public Health and the Environment. 8 August 2020. Retrieved 15 August 2020.
  25. ^ Rusiñol, M.; Zammit, I.; Itarte, M.; Forés, E.; Martínez-Puchol, S.; Girones, R.; Borrego, C.; Corominas, Ll.; Bofill-Mas, S. (15 September 2021). "Monitoring waves of the COVID-19 pandemic: Inferences from WWTPs of different sizes". Science of the Total Environment. 787: 147463. Bibcode:2021ScTEn.78747463R. doi:10.1016/j.scitotenv.2021.147463. ISSN 1879-1026. PMC 8103791. PMID 33989864.
  26. ^ Bartel, Alexander; Grau, José Horacio; Bitzegeio, Julia; Werber, Dirk; Linzner, Nico; Schumacher, Vera; Garske, Sonja; Liere, Karsten; Hackenbeck, Thomas; Rupp, Sofia Isabell; Sagebiel, Daniel; Böckelmann, Uta; Meixner, Martin (2024-01-10). "Timely Monitoring of SARS-CoV-2 RNA Fragments in Wastewater Shows the Emergence of JN.1 (BA.2.86.1.1, Clade 23I) in Berlin, Germany". Viruses. 16 (1): 102. doi:10.3390/v16010102. ISSN 1999-4915. PMC 10818819. PMID 38257802.
  27. ^ "The University of Arizona says it caught a dorm's covid-19 outbreak before it started. Its secret weapon: Poop". The Washington Post. 28 August 2020.
  28. ^ Elahi, Ehsan; Abid, Muhammad; Zhang, Liqin; Alugongo, Gibson Maswayi (July 2017). "The use of wastewater in livestock production and its socioeconomic and welfare implications". Environmental Science and Pollution Research. 24 (21): 17255–17266. doi:10.1007/s11356-017-9263-3. ISSN 0944-1344.
  29. ^ Norman, Keri N.; Scott, H. Morgan; Harvey, Roger B.; Norby, Bo; Hume, Michael E.; Andrews, Kathleen (2011-08-15). "Prevalence and Genotypic Characteristics of Clostridium difficile in a Closed and Integrated Human and Swine Population". Applied and Environmental Microbiology. 77 (16): 5755–5760. doi:10.1128/AEM.05007-11. ISSN 0099-2240. PMC 3165271. PMID 21724899.
  30. ^ Sharif S, Ikram A, et al. (24 June 2020). "Detection of SARs-CoV-2 in wastewater, using the existing environmental surveillance network: An epidemiological gateway to an early warning for COVID-19 in communities". medRxiv 10.1101/2020.06.03.20121426v3.
  31. ^ "Coronavirus traces found in March 2019 sewage sample, Spanish study shows". Reuters. 26 June 2020. Retrieved 28 July 2021.
  32. ^ Kreier F (May 2021). "The myriad ways sewage surveillance is helping fight COVID around the world". Nature. doi:10.1038/d41586-021-01234-1. PMID 33972790. S2CID 234360319.
  33. ^ Agrawal S, Orschler L, Lackner S (March 2021). "Long-term monitoring of SARS-CoV-2 RNA in wastewater of the Frankfurt metropolitan area in Southern Germany". Scientific Reports. 11 (1): 5372. Bibcode:2021NatSR..11.5372A. doi:10.1038/s41598-021-84914-2. PMC 7940401. PMID 33686189.
  34. ^ Rooney CM, Moura IB, Wilcox MH (January 2021). "Tracking COVID-19 via sewage". Current Opinion in Gastroenterology. 37 (1): 4–8. doi:10.1097/MOG.0000000000000692. PMID 33074996. S2CID 224811450.
  35. ^ Larsen DA, Wigginton KR (October 2020). "Tracking COVID-19 with wastewater". Nature Biotechnology. 38 (10): 1151–1153. doi:10.1038/s41587-020-0690-1. PMC 7505213. PMID 32958959.
  36. ^ Michael-Kordatou I, Karaolia P, Fatta-Kassinos D (October 2020). "Sewage analysis as a tool for the COVID-19 pandemic response and management: the urgent need for optimised protocols for SARS-CoV-2 detection and quantification". Journal of Environmental Chemical Engineering. 8 (5): 104306. doi:10.1016/j.jece.2020.104306. PMC 7384408. PMID 32834990.
  37. ^ Seeger C. "Abwasserbasierte EpidemiologieAbwassermonitoring als Frühwarnsystem für Pandemien" (PDF). Retrieved 28 July 2021.
  38. ^ a b de Jonge, Eline F.; Peterse, Céline M.; Koelewijn, Jaap M.; van der Drift, Anne-Merel R.; van der Beek, Rudolf F. H. J.; Nagelkerke, Erwin; Lodder, Willemijn J. (15 December 2022). "The detection of monkeypox virus DNA in wastewater samples in the Netherlands". Science of the Total Environment. 852: 158265. doi:10.1016/j.scitotenv.2022.158265. ISSN 0048-9697. PMC 9558568. PMID 36057309.
  39. ^ "Wastewater surveillance becomes more targeted in search for poliovirus, monkeypox and coronavirus". CBS News. Retrieved 18 September 2022.
  40. ^ Payne, Aaron; Kreidler, Mark (8 August 2022). "COVID sewage surveillance labs join the hunt for monkeypox". WOUB Public Media. Retrieved 18 September 2022.
  41. ^ McPhillips, Deidre (18 May 2022). "Covid-19 wastewater surveillance is promising tool, but critical challenges remain". CNN. Retrieved 2 February 2023.
  42. ^ Reardon, Sara. "Wastewater Monitoring Offers Powerful Tool for Tracking COVID and Other Diseases". Scientific American. Retrieved 2 February 2023.
  43. ^ Diamond, Megan B.; Keshaviah, Aparna; Bento, Ana I.; Conroy-Ben, Otakuye; Driver, Erin M.; Ensor, Katherine B.; Halden, Rolf U.; Hopkins, Loren P.; Kuhn, Katrin G.; Moe, Christine L.; Rouchka, Eric C.; Smith, Ted; Stevenson, Bradley S.; Susswein, Zachary; Vogel, Jason R.; Wolfe, Marlene K.; Stadler, Lauren B.; Scarpino, Samuel V. (October 2022). "Wastewater surveillance of pathogens can inform public health responses". Nature Medicine. 28 (10): 1992–1995. doi:10.1038/s41591-022-01940-x. ISSN 1546-170X. PMID 36076085. S2CID 252160339.
  44. ^ Anthes, Emily (20 January 2023). "A New Report Outlines a Vision for National Wastewater Surveillance". The New York Times. Retrieved 2 February 2023.
  45. ^ a b c Munk, Patrick; Brinch, Christian; Møller, Frederik Duus; Petersen, Thomas N.; Hendriksen, Rene S.; Seyfarth, Anne Mette; Kjeldgaard, Jette S.; Svendsen, Christina Aaby; van Bunnik, Bram; Berglund, Fanny; Larsson, D. G. Joakim; Koopmans, Marion; Woolhouse, Mark; Aarestrup, Frank M. (1 December 2022). "Genomic analysis of sewage from 101 countries reveals global landscape of antimicrobial resistance". Nature Communications. 13 (1): 7251. Bibcode:2022NatCo..13.7251M. doi:10.1038/s41467-022-34312-7. ISSN 2041-1723. PMC 9715550. PMID 36456547.
  46. ^ "Antibiotika-Resistenzen verbreiten sich offenbar anders als gedacht". Deutschlandfunk Nova (in German). Retrieved 17 January 2023.
  47. ^ Singer, Andrew C.; Thompson, Janelle R.; Filho, César R. Mota; Street, Renée; Li, Xiqing; Castiglioni, Sara; Thomas, Kevin V. (2023-05-22). "A world of wastewater-based epidemiology". Nature Water. 1 (5): 408–415. doi:10.1038/s44221-023-00083-8. ISSN 2731-6084.
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