Lab Matters Fall 2024 | Page 134

APHL 2024 POSTER ABSTRACTS

response to the confirmed case of paralytic poliomyelitis in Rockland County , NY and subsequent WS poliovirus detections in Rockland and neighboring counties .

In collaboration with Discovery Partners Institute ( DPI ), an academic laboratory in the University of Illinois System and the Regional Innovative Public Health Laboratory ( RIPHL ), a public health / academic partnership with Rush University Medical Center , CDPH uses WS to monitor the status of poliovirus in three wastewater treatment plants ( WWTPs ) serving Chicago and surrounding areas within Cook County .

Additionally , CDPH developed a tabletop exercise to ( i ) test the capacity of the existing WS system to track new pathogens of concern and ( ii ) plan a response strategy for the event of a WS poliovirus detection .

Methods : From March 5 through July 2 , 2023 ( MMWR weeks 11- 27 ), four biweekly samples were taken from WWTPs for 17 weeks or three infection cycles ( n = 36 samples ). Each sampling site serves ≥ 1 million people . RNA was extracted from each sample at DPI and was then processed at RIPHL for sequencing . After reverse transcription , complementary DNA ( cDNA ) was processed using PCR amplification with a panenterovirus primer set targeting the viral capsid coding region ( VP1 ). Subsequently , three different primer sets , including Enterovirus C and poliovirus type 2-specific primer sets , were employed using a nested PCR protocol . All internal primers contained Oxford Nanopore linkers , allowing for rapid barcoding . Methods were adapted from the procedure described by Tedcastle et al . ( 2022 ). After amplification to incorporate barcodes , PCR products were sequenced using an Oxford Nanopore MinION instrument to identify enterovirus or specific poliovirus type including Sabin-like poliovirus types 1 , 2 and 3 and wild poliovirus using the software package Piranha . Results of sequenced samples were shared with CDPH with a total turnaround time from sample collection to results of ten days .

A CDPH tabletop exercise was initiated with representatives from communications , disease control , epidemiology , preparedness and youth settings teams . Actions included drafting communications to providers and the public , verifying immunization coverage , developing plans for scaling-up WS and vaccination drives .

Results : The WS surveillance did not detect poliovirus in sampled WWTPs . Combined with no contemporaneous reports of paralytic polio or acute flaccid myelitis , findings indicate no evidence of poliovirus shedding that could infect and cause disease in people who are not vaccinated against polio .

Conclusions : CDPH demonstrated Chicago could stand up poliovirus WS and associated public health actions in response to an emergent outbreak . The ability to initiate this program underscored our current capacity and the need for maintaining an ongoing wastewater monitoring infrastructure in the city so that ( re ) emergent public health threats can be quickly assessed .

Presenter : Alyse Kittner , alyse . kittner @ cityofchicago . org

Moving Beyond COVID-19 : Two-year Wastewater Monitoring for Influenza and Respiratory Syncytial Virus , A Comparison to Clinical Cases

R . Fahney 1 , A . Roguet 1 , D . Everett 1 , A . Bateman 1 , S . Buechner 1 , E . Hanson 1 , N . Kloczko 2 , M . Schussman 3 , M . Rasmussen 4 , J . Hemming 1 , S . McLellan 3 , D . Antkiewicz 1 , M . Shafer 1 , Wisconsin State Laboratory of Hygiene 1 , Bureau of Communicable Diseases , Wisconsin Department of Health Services 2 , School of Freshwater Sciences , University of Wisconsin-Milwaukee 3 , Wisconsin Department of Health Services 4

Wastewater-based surveillance ( WBS ) has recently gained recognition as a complementary and independent epidemiological tool for monitoring community levels of SARS-CoV-2 , the agent causing COVID-19 . Wastewater surveillance can provide an early warning of disease transmission and variant spread in communities . By picking up the signal from asymptomatic or mild cases that can go undetected in the healthcare system , it can foreshadow the clinical case data . In addition , WBS provides better equity in public health surveillance as all communities served by a sewer system are equally tested , while traditional health surveillance can overlook populations that lack access to health services despite being at the highest risk for poor health outcomes . Leveraging wastewater-based surveillance , public health officials can better understand disease burden in these vulnerable communities .

In 2020 , the Wisconsin State Lab of Hygiene ( WSLH ) in collaboration with partners at the University of Wisconsin-Milwaukee and the Wisconsin Department of Health Services ( DHS ), built and implemented a statewide wastewater surveillance network for SARS- CoV-2 . Disease surveillance has since been expanded to include influenza A and B and respiratory syncytial virus ( RSV ), utilizing similar techniques as routine COVID-19 wastewater monitoring methods . For two respiratory disease seasons ( 2022-2023 and 2023-2024 ), influenza and RSV viral loads were measured twice weekly in wastewater from multiple communities across the state . By comparing clinical PCR test positivity rates with pathogen levels measured in wastewater , we show that both data sets mirror each other and follow similar trends . Our analysis was specifically based on PCR results rather than syndromic data ( ESSENCE ) to allow for more direct and specific comparisons between the data sets . We report that WBS could serve as an early indication of increased influenza A circulation , leading clinical increases by 0-2 weeks , while clinical cases were a leading indicator by 0-4 weeks for RSV . In comparison , WBS can lead clinical detection by up to one week for SARS-CoV-2 . Additionally , the two-year surveillance of these pathogens allowed for sentinel wastewater treatment plant facilities to be identified and potential public health action thresholds to be developed to help identify future viral outbreaks via wastewater , allowing health departments to respond accordingly . This demonstrates that WBS can be complementary to and used alongside traditional epidemiological methods .

Presenter : Rebecca Fahney , Rebecca . Fahney @ slh . wisc . edu