In the Literature

Abstract

Karthikeyan S, Levy JI, De Hoff P, et al. Wastewater sequencing reveals early cryptic SARS-CoV-2 variant transmission. Nature. 2022 Jul 7. https://doi.org/10.1038/s41586-022-05049-6. Epub ahead of print. PMID: 35798029. In 1939 at Yale University, Patel and colleagues detected poliovirus in the wastewater of 2 urban areas in an attempt to understand the epidemiology of ongoing polio outbreaks [1, 2]. The role of this surveillance method for poliovirus has recently been reemphasized due to the emergence of poliovirus in wastewater in London and New York, the latter associated with the first human case in the United States since 1979. Wastewater monitoring is now increasingly used to surveil severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and, recently, monkeypox virus and has also been applied to monitoring of bacterial genes associated with antimicrobial resistance. Active SARS-CoV-2 surveillance has a number of important potential public health benefits, including detection of new viral variants. Early detection and evidence of increasing prevalence in wastewater has a number of implications, including understanding transmissibility and monitoring the community-wide efficacy of prophylactic and therapeutic interventions. Standard surveillance of SARS-CoV-2 depends on the collection of clinical specimens, but this nonsystematic approach usually has inevitable biases that may adversely affect surveillance data. Wastewater surveillance provides an attractive alternative but, as pointed out by Karthikeyan and colleagues, it has been limited by “low quality sequence data and inability to estimate relative lineage abundance in mixed samples,” problems that these investigators have addressed.