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Thank you for visiting nature. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. Wastewater-based epidemiology has been used in pathogen surveillance for microorganisms at the community level. This study was conducted to determine the occurrence and trends of infectious pathogens in sewage from Yongin city and the relationships between these pathogens and the incidence of infectious diseases in the community. From December to November , we collected inflow water from six wastewater treatment plants in Yongin city twice a month. The analyzed microorganisms included 15 respiratory viruses, 7 pneumonia-causing bacteria, 19 acute diarrhea-causing pathogens, SARS-CoV-2, Zika virus, hepatitis A virus, poliovirus, Mpox, and measles. The concentrations of 9 pathogens among them were additionally analyzed using quantitative real time PCR. The correlation was confirmed through statistical analysis with the rate of detection for pathogens reported by the Korea Disease Control and Prevention Agency. Influenza A virus, human adenovirus, and human rhinovirus were moderately correlated rho values of 0. Campylobacter spp. Enteropathogenic E. We were able to identify the prevalence of respiratory viral infections, pneumonia, and acute diarrhea-causing pathogens in the community through wastewater-based epidemiology data. This study will be helpful in establishing a system for future surveillance of infectious diseases present in sewage. The global COVID pandemic has highlighted the importance of proactive surveillance and response to infectious diseases within communities. As a result, wastewater-based surveillance systems have gained significant attention in many countries, including the United States, Europe, and Japan, and are being actively incorporated into national infectious disease surveillance policies 1 , 2. Surveys for the detection of infectious pathogens in sewage are emerging as an innovative, multifaceted approach with broad implications for public health management. National Institutes of Health NIH and various international organizations recognize the serious impact that infectious diseases have on communities around the world and are actively developing effective prevention and prediction systems 3. The sewage surveillance system is being studied based on reports that bacteria and viruses are present in sewage that local residents discharge through daily use. Pathogens can be detected using the nucleic acids present in sewage. Measuring the concentration of pathogens in sewage is an important indicator of the prevalence of pathogen infections in an area 4. In addition, the sewage monitoring system allows monitoring by period and region without infringing on individual privacy, enabling early detection of new infectious pathogens 5 , 6. In this study, we aimed to investigate and report the detection rates of 7 pneumonia-causing bacteria, 19 acute diarrhea-causing bacteria and viruses, 15 respiratory viruses, SARS-CoV-2, Zika virus, hepatitis A virus, poliovirus, Mpox, and measles among the most common infectious pathogens in Korea from December to November in sewage collected from six wastewater treatment plants WWTPs in Yongin city. The respiratory virus data in the surveillance report and the pathogen data of acute diarrhea cases were derived from genetic testing results of samples collected from more than 70 medical institutions nationwide. Therefore, we would like to report by analyzing the correlation between the nucleic acid concentrations of the nine pathogens detected in sewage and the weekly pathogen and vector surveillance results announced by the KDCA. PCR tests were performed for 47 species of pathogens during the study period, most of which pathogens associated with respiratory infections, diarrhea, and pneumonia were detected. Few clinical cases of Zika virus, HAV, poliovirus, Mpox, and measles were reported in the community during the study period. The absence of these pathogens in sewage aligns with the lack of clinical cases, indicating that there was no active transmission in the community at that time Table 1. The detection results are expressed as the ratio of the number of detections for each respiratory virus out of 24 total detections. This is the result of analyzing the influent water from six WWTPs for one year, twice a month, for a total of 24 times. Among the 13 types of bacteria that cause acute diarrhea, Aeromonas spp. The next most commonly found were enteroinvasive E. Shigella spp. Salmonella spp. Considering the change in nucleic acid concentration in sewage for each pathogen during the study period, the concentration of IAV was mainly high in sewage during the cold season, from November to December, and showed a sharp increase, especially toward the end of October. It was barely detected in March and April Fig. In the case of HAdV, a respiratory virus, the concentration was low from February to June, but in the fall September , the increase was greater than before Fig. They were rarely detected from June to September, and mainly in winter November to February , when the concentration in sewage was significantly greater than in other seasons. Among the three subtypes, E and OC43 had higher concentrations than NL63, indicating that these two subtypes are dominant Fig. The concentration of HRV in sewage was greater in fall and winter September to November than in spring and summer. The trend toward an increase or decrease in the nucleic acid concentration in sewage was similar to that reported by the KDCA Fig. Compared with other pathogens, the concentrations of Campylobacter spp. The rate of detection for each respiratory virus reported weekly by the KDCA and the concentration of each virus detected at the six WWTPs were analyzed and are presented in a graph. For human coronavirus, three subtypes were analyzed shown in orange for human coronavirus E, gray for OC43, and yellow for NL64 , and the viral concentrations of human coronavirus represent the sum of the three types. Correlation between the weekly rate of detection for pathogens causing acute diarrheal disease from KDCA and the concentration of pathogens detected in the six WWTPs. The weekly detection rate of each pathogen causing acute diarrheal disease by the KDCA report and the concentration of each pathogen detected in the six WWTPs were analyzed and are presented in a graph. A Campylobacter spp. The trend in the concentrations of the four causative agents of acute diarrheal disease detected in sewage was very similar to the trend in the rates of detection reported by the KDCA. Moreover, some microorganisms had higher or lower rates of detection for certain conditions Fig. These changes may be related to the seasonal transmission pattern of the virus. Trends in the rates of detection of pathogens in sewage by season. The graph shows the trend of the rates of detection of each pathogen in sewage by season. For each pathogen, the change in the rate of detection over 3 months is shown. Among the pathogens causing acute diarrhea, Y. This is consistent with the fact that warmer temperatures generally promote the growth of these microorganisms. The concentration of each pathogen was converted to copies from the Ct value using the standard curve. The concentrations obtained from the six WWTPs were pooled. The positivity rate of pathogens was obtained from the KDCA data. The correlation of these two values was evaluated using Spearman rank correlation. This study yielded very significant results between the nucleic acid concentration of pathogens detected in sewage and the pathogen detection rate reported by the KDCA. For Campylobacter spp. All the significant pathogens had p-values less than 0. For these eight pathogens, all p-values were less than 0. It was confirmed that there was no strong association between the national data and Yongin city sewage data. In this study, the presence of various pathogens, such as respiratory viruses, pneumonia-causing bacteria, acute diarrhea-causing bacteria and viruses, was confirmed in sewage collected from six WWTP sites in Yongin, Gyeonggi-do, Korea. Specifically, this study significantly expanded the sewage surveillance analysis for a total of 47 pathogens, including 15 respiratory viruses, 7 pneumonia-causing bacteria, 19 acute diarrhea-causing viruses and bacteria, SARS-CoV-2, Zika virus, HAV, poliovirus, Mpox, and measles, among other collected sewage. This is thought to have been influenced by the number of infants and young children 7. In the case of the WWTP D region, there were more residential areas compared to other regions, and the number of populations was much higher than other regions. In particular, the population of infants and young children 0—14 years old was 4 to 10 times higher than in other regions 8. For this reason, it is hypothesized that HAdV, which mainly infects infants and young children, showed the highest detection rate in the WWTP D region. Among the bacteria that cause pneumonia, H. Additionally, L. There are still limited data on sewage analysis for pneumonia-causing bacteria, so further research is necessary to improve the accuracy and reliability of the data obtained from sewage analysis. In this study, in addition to respiratory viruses, bacteria and viruses that cause acute diarrhea were also analyzed. Among the 13 types of diarrhea-causing bacteria, Aeromonas spp. In contrast, Shigella spp. These results are consistent with the report that the eae gene of EPEC was detected in all samples as a result of E. Enteric adenovirus, group A rotavirus, astrovirus, and NoV GI also showed high detection rates, but SV was irregularly detected in sewage samples. Moreover, the trend of increasing concentrations of NoV GII during the cold season was also observed The results of enteric adenovirus were similar to those of a study in which adenoviruses were detected in The virus was found to be more closely related to diarrhea-causing pathogens than to respiratory pathogens, making it suitable for the surveillance of gastrointestinal infections According to data reported by the Korea Centers for Disease Control and Prevention in —, acute diarrhea-causing bacteria and viruses are seasonal, and norovirus is usually prevalent from winter to spring and bacteria such as pathogenic E. In addition, it is known that the prevalence of respiratory viruses also shows seasonality We think that the prevalence of these pathogens could be confirmed by sewage analysis, and the pathogens showing good seasonality were selected from the sewage data and plotted as a graph. In the case of norovirus, the cause of acute diarrhea, the concentration of virus in sewage increased mainly in winter rather than in summer. This was consistent with the results of the surveillance report in South Korea, which reported that bacterial-induced acute diarrheal disease frequently occurs in summer and autumn, and that there is a high prevalence of the virus in spring and winter In the case of para-influenza, it was mainly detected in sewage from winter to spring during the study period — , which was inconsistent with the generally known prevalence of para-influenza, from April to August. However, in Korea from to , there have been reports that para-influenza has rather increased detection rates in winter since the outbreak of COVID This finding was similar to the results of the present study. Therefore, monitoring various pathogens in sewage may be useful for monitoring pathogens that are prevalent mainly seasonally in Korea. Notably, this study included an additional analysis of nucleic acid concentrations for 9 specific pathogens that can be compared with the weekly pathogen and vector surveillance results published by the KDCA. We analyzed the correlation between the nucleic acid concentrations of the 9 pathogens detected in sewage and the weekly pathogen and vector surveillance results announced by the KDCA. This highlights the usefulness of sewage surveillance tools and is consistent with other studies showing that sewage has potential utility in monitoring pathogens 21 , Other studies have reported variations in the amount and duration of viral RNA shedding by infected individuals due to this cause. It has been reported that this variability may affect the concentration of viral RNA detected in wastewater samples and may not be directly correlated with the number of clinical cases 23 , However, monitoring of SARS-CoV-2 mutant strains in local domestic sewage through Nanopore Sequencing, another study currently underway within the institution, was conducted. Afterward, in November , HK. By comparing the SARS-CoV-2 mutant strains detected in sewage with the monthly SARS-CoV-2 mutation trend, it is possible to identify the timing of occurrence of specific mutations and predict mutations in major strains of the virus circulating in a specific region Supplementary Figs. S2 and S3 Unfortunately, this study is limited in that it was not able to directly compare the results with community clinical data from six WWTP areas where wastewater was collected. This was not easy to compare because there were no published clinical data from each community. A comparison of the results of sewage pathogen analysis in some areas Yongin city with the results of national infectious disease surveillance samples is clearly limited. We also know that there is a limitation in not fully reflecting the difference in inflows according to the sewage treatment plant and not reflecting the various types of buildings distributed in each sewage treatment plant area. Therefore, in future studies, it is thought that more accurate data could be grasped only by analyzing sewage collected by building e. Despite these limitations, in the case of infectious disease surveillance using sewage, patient surveillance will be possible without infringing on individual privacy. In addition, monitoring by period and region is possible, and it is expected that the cost reduction effect will be greater than that of clinical surveillance for the purpose of prior monitoring 21 , Furthermore, it will be possible to monitor not only SARS-CoV-2 but also various pathogens related to public health, such as viral mutations, antibiotic-resistant bacteria, and factors associated with waterborne diseases, in sewage. Research on sewage-based surveillance, also known as wastewater-based epidemiology WBE , has been consistently conducted overseas. Pathogen and health indicator monitoring can be performed by analyzing various types of information in sewage samples. This is achieved by analyzing information on biomarkers present in sewage and bowel movements discharged by local residents with confirmed infectious diseases Sewage-based biomechanics is a technology that is already being introduced in countries with serious public health issues related to drug problems. It is used as a means to prevent health risks to local residents and to monitor criminal organizations by tracking and analyzing sewage discharged after use by local residents. This helps calculate the usage amount and discharge area for drugs such as cocaine, ecstasy, and marijuana 28 , In particular, since the onset of the COVID pandemic in December , the utilization of wastewater-based surveillance technology has expanded globally. This technology is used to monitor and manage symptomatic and asymptomatic infections. It serves as an auxiliary means of clinical surveillance, which typically detects only symptomatic infections Since , the KDCA has been conducting sewage-based infectious disease monitoring through a pilot project, and based on this, it is working with 18 public health and environmental research institutes across the country to carry out sewage-based infectious disease monitoring KOWAS projects including pathogens such as SARS-CoV-2, norovirus, human influenza virus A and B , and antibiotic-resistant strains 32 , The system we have developed is easy and simple to detect pathogens in sewage, and since it has a system that can detect 47 different types of pathogens, we believe it will be of great help in expanding the sewage surveillance system of national organizations in the future. Sewage generated from the community contains valuable information about the living patterns and health status of residents. Although the comparative analysis data were limited, the pathogens analyzed in this study were found to be present in the community or strongly suspected. Numerous studies have been conducted on surveillance systems using wastewater. However, there has never been a study in the world in which various pathogens 47 types such as respiratory viruses, pneumonia-causing bacteria, diarrhea-causing bacteria, and viruses have been detected, as in this study. The research revealed that not only respiratory viruses but also pneumonia-causing bacteria, acute diarrheal pathogens, and viruses were detected in sewage. Moreover, a correlation was observed between the nucleic acid concentration and the incidence of infectious diseases. This is the first time that such a wide-ranging infectious disease surveillance study has been attempted in Korea. The results of this study suggest the possibility of expanding the wastewater pathogen surveillance system in Korea, including wastewater collection, nucleic acid extraction, pathogen detection, and quantitative analysis. Additionally, to overcome the limitations of this study, it is anticipated that actively investigating the clinical data in community medical institutions in the future will enable a more accurate comparative analysis. This, in turn, will help in building a more effective wastewater monitoring system, aiding in predicting the prevalence of infectious diseases in the community. This study was conducted by examining sewage from a WWTP in Yongin city to determine whether pathogens such as SARS-CoV-2, influenza, and acute diarrhea-causing pathogens were occurring and trending and whether they were prevalent. The analyzed pathogens included 15 types of respiratory viruses, 7 types of pneumonia-causing bacteria, 19 types of acute diarrhea-causing bacteria and viruses, SARS-CoV-2, Zika virus, hepatitis A virus HAV , poliovirus, Mpox, and measles Table 5. Nucleic acids from viruses or bacteria were extracted, and various pathogens were detected through real-time and conventional PCR. Additionally, for some pathogens, the concentration of the pathogen in sewage was calculated, and the correlation with the rate of detection for each pathogen reported by the KDCA was confirmed through statistical analysis. S1 twice a month a total of 24 times at volume of 1. A total of samples were analyzed. In this kit, the sample is concentrated using magnetic beads, followed by nucleic acid extraction also utilizing magnetic beads. The experiment was conducted following the guidelines outlined in the user manual provided by the manufacturer Supplementary information : Sample concentration and nucleic acid extraction. In this study, a variety of pathogens were analyzed. Positive and negative controls were included throughout the entire process to ensure the reliability of the PCR and real-time PCR results. The negative controls showed no amplification for all targets analyzed. Positive controls yielded the expected positive results, with consistent values measured for each PCR run. We generated a standard curve using standard materials whole genome for bacteria and viruses Supplementary Table S2. Additional information on standard curves is provided in the supplementary information Supplementary Table S4. This standard curve was used to determine the concentration of specific pathogens in sewage and compared the trends in pathogen concentration and positivity rates. The pathogen detection rate in clinical samples was compared and analyzed with the weekly pathogen detection data provided by the KDCA. In the case of pathogen concentration values detected in domestic sewage, the pathogen concentrations in the sewage for each WWTP were first calculated and subsequently summed. This correlation was confirmed by comparing the pathogen concentration data obtained from sewage samples with weekly detection rate of each pathogen reported by the KDCA. In the case of correlation analysis, all data from the 1st to the 24th were analyzed, and in the case of non-detect, whether it is clinical data or sewage data, it is marked as 0 and included in the analysis. Statistical analysis was performed using RStudio R version 4. The respiratory virus data in the weekly surveillance reports were derived from genetic tests on suspected respiratory virus infection patients from 77 medical institutions nationwide conducted by the Infectious Disease Diagnostic Analysis Division of the KDCA 20 , In addition, data published by the KDCA using the number of reports of acute diarrhea disease from 70 medical institutions nationwide were utilized 19 , We analyzed the correlation by comparing disease surveillance data from KDCA with trends in pathogen concentrations detected in sewage during the study period. The main data supporting the results of this study are available within the paper and its Supplementary Information. Wu, F. Water Res. Benedetti, et al. A survey of the representativeness and usefulness of wastewater-based surveillance systems in 10 countries across Europe in Eurosurveillance 29 33 , Bowes, D. Leveraging an established neighbourhood-level, open access wastewater monitoring network to address public health priorities: a population-based study. Lancet Microbe 4 , e29—e37 Article PubMed Google Scholar. Xiao, K. Wastewater pathogen surveillance based on one health approach. Lancet Microbe 4 , e Soni, V. Surveillance of omicron variants through wastewater epidemiology: latest developments in environmental monitoring of pandemic. Total Environ. Jose, J. The need for wastewater surveillance of enteroviruses in the Philippines. Lancet Microbe 3 , e Shieh, W. Human adenovirus infections in pediatric population - an update on clinico-pathologic correlation. Yongin Statistics. Population and household statistics Ahmed, W. Occurrence of multiple respiratory viruses in wastewater in Queensland, Australia: potential for community disease surveillance. Boehm, A. Wastewater concentrations of human influenza, metapneumovirus, parainfluenza, respiratory syncytial virus, rhinovirus, and seasonal coronavirus nucleic-acids during the COVID pandemic: a surveillance study. Lancet Microbe. Hughes, B. Wolfe, M. Wastewater-based detection of two influenza outbreaks. Dumke, R. Env Res. Article Google Scholar. Mercier, E. Municipal and neighbourhood level wastewater surveillance and subtyping of an influenza virus outbreak. Wastewater surveillance of human influenza, Metapneumovirus, parainfluenza, respiratory syncytial virus RSV , rhinovirus, and seasonal coronaviruses during the COVID pandemic. Yang, K. Estimating the prevalence of potential enteropathogenic Escherichia coli and intimin gene diversity in a human community by monitoring sanitary sewage. Wang, H. Variations among viruses in influent water and effluent water at a wastewater plant over one year as assessed by quantitative PCR and metagenomics. Pellegrinelli, L. Wastewater surveillance captured an increase in adenovirus circulation in Milan Italy during the first quarter of Eonjoo et al. Waterborne and foodborne disease outbreaks in metropolitan areas of the Republic of Korea, Health Wkly. Google Scholar. SangHee et al. Korea — influenza and respiratory viruses laboratory surveillance report. Sangsanont, J. Li, X. Hassard, F. Wastewater surveillance for rapid identification of infectious diseases in prisons. Karthikeyan, S. Paterson, B. Wastewater surveillance: an effective and adaptable surveillance tool in settings with a low prevalence of COVID Lancet Planet. Lim, S. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, — a systematic analysis for the global burden of disease study World Drug Report Accessed 16 February Lodder, W. Lancet Gastroenterol. Jin-Hwa, J. Establishment and operation of national wastewater-based surveillance system on infectious diseases. Yang, Q. Interphylum dissemination of NDMpositive plasmids in hospital wastewater from Fuzhou, China: a single-centre, culture-independent, plasmid transmission study. Download references. We deeply appreciate the dedicated employees of Yongin City Hall and six sewage treatment plants in Yongin City for their valuable support and cooperation during this study. SCL Healthcare Inc. Gyeonggi-do, Yongin-si, Gyeonggi-do, Republic of Korea. You can also search for this author in PubMed Google Scholar. Yun-Tae Kim and Bokyung Son drafted the manuscript. Kyungwon Lee and Hyukmin Lee provided critical revision. Correspondence to Yun-Tae Kim. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and permissions. Kim, YT. Development of a wastewater based infectious disease surveillance research system in South Korea. Sci Rep 14 , Download citation. Received : 31 July Accepted : 15 October Published : 19 October Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Sign up for the Nature Briefing: Microbiology newsletter — what matters in microbiology research, free to your inbox weekly. Skip to main content Thank you for visiting nature. Download PDF. Subjects Epidemiology Microbiology Pathogens Policy and public health in microbiology Water microbiology. Abstract Wastewater-based epidemiology has been used in pathogen surveillance for microorganisms at the community level. Municipal and neighbourhood level wastewater surveillance and subtyping of an influenza virus outbreak Article Open access 22 September Introduction The global COVID pandemic has highlighted the importance of proactive surveillance and response to infectious diseases within communities. Results PCR tests were performed for 47 species of pathogens during the study period, most of which pathogens associated with respiratory infections, diarrhea, and pneumonia were detected. Table 1 Types of viruses and bacteria analyzed in this study. Full size table. Table 3 Detection rates of acute diarrhea-causing bacteria and viruses in wastewater samples collected from six WWTPs in Yongin, Korea. Figure 1. Full size image. Figure 2. Figure 3. Discussion In this study, the presence of various pathogens, such as respiratory viruses, pneumonia-causing bacteria, acute diarrhea-causing bacteria and viruses, was confirmed in sewage collected from six WWTP sites in Yongin, Gyeonggi-do, Korea. Methods Study design This study was conducted by examining sewage from a WWTP in Yongin city to determine whether pathogens such as SARS-CoV-2, influenza, and acute diarrhea-causing pathogens were occurring and trending and whether they were prevalent. PCR analysis In this study, a variety of pathogens were analyzed. Data availability The main data supporting the results of this study are available within the paper and its Supplementary Information. References Wu, F. Article Google Scholar Mercier, E. Google Scholar SangHee et al. Google Scholar Ahmed, W. Google Scholar Yang, Q. Acknowledgements We deeply appreciate the dedicated employees of Yongin City Hall and six sewage treatment plants in Yongin City for their valuable support and cooperation during this study. View author publications. Ethics declarations Competing interests The authors declare no competing interests. Supplementary Information. Supplementary Material 1. About this article. Cite this article Kim, YT. 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