Oz Sentinel: Mainstreaming Wastewater-based Epidemiology to Improve Health Outcomes

The COVID-19 pandemic has shown that we need better surveillance of infectious and antimicrobial agents, in the community:

• For detection of outbreaks earlier than is possible by routine clinical testing
• To characterise the prevalence of infectious and antimicrobial agents within a community, including the presence of asymptomatic/pre-symptomatic infections
• To reveal the presence of pathogens that are entirely new to a region or country
• To reveal changes in pathogen prevalence and genetic composition

Australia does not have a well-established national surveillance and response program. Wastewater-based epidemiology (WBE) has the potential to provide insights into a broad range of infectious disease and antimicrobial agents and biomarkers. Furthermore, WBE surveillance data has to be integrated with health data leading to beneficial health responses.

The main objective of this project is to establish a nationwide sewage surveillance of agents of concern through wastewater monitoring. During non-epidemic periods, insight into the community agent load and early warning for an increase in agents will be the outcome. During epidemics, this should be in near-real time. Findings should always be integrated with human epidemiological dynamics and processes.

This project will deliver the following:

(1) Early warning system to detect:

1. Presence of a pathogenic threat

                  i.    Routine surveillance to detect the new presence of:

1. A known pathogen (i.e. SARS-CoV-2)
2. Novel pathogens (i.e. variant of swine flu)

                   ii.    Targeted surveillance in high risk settings (i.e., ‘hotspots’, prisons, nursing homes, etc)

2. Estimate the community burden of a known pathogen in a previously low prevalence setting (consistency of positivity, increase in viral load)

(2) Monitor the impact of strategies aimed at containment, treatment, immunisation
         a. Routine surveillance
         b. Targeted surveillance in high prevalence or high-risk settings

(3) Inform the impact of “re-opening” strategies on the burden of community disease
         a. Routine surveillance
         b. Targeted surveillance in high prevalence or high-risk settings

Expected outcomes

• Optimised sampling programs for ongoing surveillance, and a capacity to rapidly model emerging outbreaks in order to identify where best to sample.
• Optimised protocols for sample collection, pre-processing, local storage, shipment, archiving and detection of infectious and antimicrobial agents; including the potential for robotic and IoT devices in-sewer execution of collection, pre-processing, and detection.
• Cloud-hosted software (coupled hydrodynamic-epidemiology) for use on a subscription basis (commercial outcome).
• Pre-processing, storage and shipment solutions and services (commercial outcomes) Improved community health.