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ORIGINAL RESEARCH article

Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1462186
This article is part of the Research Topic Emerging Pathogens and Contaminants in the Environment: Human Health Risks, Exposure Pathways and Epidemiological Outcomes View all articles

Evaluation of Wastewater Surveillance for SARS-CoV-2 in a Prison Population: A Mixed-Methods approach

Provisionally accepted
Gethin Jones Gethin Jones 1*Andrew Nelson Andrew Nelson 1David R. Chadwick David R. Chadwick 2Steve Cobley Steve Cobley 1Davey Jones Davey Jones 2Stephanie Perrett Stephanie Perrett 3William B. Perry William B. Perry 4Andrew J. Weightman Andrew J. Weightman 4Rachel C. Williams Rachel C. Williams 2Daniel R. Thomas Daniel R. Thomas 5
  • 1 Other, Cardiff, United Kingdom
  • 2 College of Environmental Sciences and Engineering, Bangor University, Bangor, United Kingdom
  • 3 Communicable Disease Inclusion Health Programme, Public Health Wales, Cardiff, United Kingdom
  • 4 School of Biosciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
  • 5 Public Health Wales NHS Trust, Cardiff, United Kingdom

The final, formatted version of the article will be published soon.

    Background: Prisons are high-risk settings for the transmission of communicable disease. Robust surveillance systems are required to identify and control outbreaks. Wastewater surveillance for SARS-CoV-2 was introduced in four prisons in Wales in March 2022. We investigated its contribution to the COVID-19 surveillance programme. Methods: We evaluated prison wastewater surveillance against eight system attributes using a mixed-methods approach. Semi-structured interviews were completed with key stakeholders to assess usefulness, flexibility and acceptability. Quantitative analyses were completed to assess data quality, sensitivity, positive-predictive value, representativeness and timeliness. To assess sensitivity of the system to detect changes in incidence we carried out a time-series analysis comparing levels of virus in wastewater with trends in confirmed COVID-19 cases from clinical surveillance. Results: Interviews with stakeholders indicated that wastewater surveillance is a useful adjunct to existing case-based surveillance. However, it had limited influence on action taken within the prison, often lagging behind existing surveillance and not specific enough to target interventions. The novelty of wastewater surveillance meant stakeholders lacked confidence in interpreting the data. Despite these limitations, wastewater surveillance detected changes in SARS-CoV-2 activity in Welsh prison populations which corroborated trends in case surveillance. Conclusion: Prison wastewater surveillance, implemented in Wales for a period during the COVID-19 pandemic, was useful and should be considered as part of a wider surveillance programme in response to future SARS-CoV-2 waves, or in response to future pandemics. It is particularly beneficial in the absence of comprehensive clinical testing. We identified several limitations to address should this surveillance be re-started.

    Keywords: Surveillance evaluation, wastewater, Monitoring, Prisons, mixed-methods, COVID-19, SARS-CoV-2

    Received: 09 Jul 2024; Accepted: 14 Oct 2024.

    Copyright: © 2024 Jones, Nelson, Chadwick, Cobley, Jones, Perrett, Perry, Weightman, Williams and Thomas. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Gethin Jones, Other, Cardiff, United Kingdom

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.