Supporting Polio and Mpox Population Surveillance Through Wastewater Testing
By Meghan Fuschino , MS , Viral Diseases director of operations and associate director of Virology , New York State Department of Health ; Mohammed A . Alazawi , PhD , program research specialist and manager , Wastewater Surveillance Program , New York State Department of Health ; Alejandro Godinez , MPH , program research specialist , New York State Department of Health ; Daniel C . Lang , MS , PG , deputy director , Center for Environmental Health , New York State Department of Health ; Milagros Neyra , MPH , project director , Syracuse University ; Kirsten St . George , PhD , chief of Viral Diseases and director of Virology , State University of New York at Albany ; Jeff Lahti , environmental microbiology supervisor , Washington State Department of Health Public Health Laboratories ; and Erin Morin , MHS , specialist , Environmental Health
Wastewater surveillance proved to be a successful early-warning , populationlevel , trend detection system during the COVID-19 pandemic . Now , it is developing into a versatile tool for public health as laboratories start to use this testing to monitor for other pathogens of concern .
New York State Department of Health
In July 2022 , the New York State Department of Health ( NYSDOH )
and the Rockland County Department of Health ( RCDOH )
were alerted to a confirmed poliomyelitis case in Rockland County . 1 , 2
Stored extracts from SARS-CoV-2
samples collected from March-July 2022 in the treatment plants within neighboring counties of concern were processed and analyzed collaboratively by the US Centers for Disease Control and Prevention ( CDC
), the Wadsworth Center
and Quadrant Biosciences for poliovirus . Assays were standard enterovirus surveillance real time reverse transcription polymerase chain reaction ( RT-PCR ) assays , followed by VP1 region sequencing . Among these stored extracts , 24 samples from Rockland , Orange , Kings , Richmond and Sullivan counties tested positive for poliovirus , with 17 samples from Rockland , Orange and Sullivan counties genetically linked to the poliomyelitis case .
These positives justified expanding poliovirus surveillance efforts to each participating site within the counties surrounding Rockland County . NYSDOH and RCDOH also worked together to identify sampling points upstream from select treatment plants and deployed portable autosamplers to locate affected communities within Rockland County .
RCDOH and NYSDOH personnel coordinating the deployment of a portable autosampler for upstream sampling in Rockland County in August 2022 . Photo : RCDOH
The public was alerted to the presence of polio in their wastewater and informed about the importance of polio vaccinations . 3 , 4
Strategies were then developed to increase polio vaccinations in the communities with persistent poliovirus detection in wastewater , low vaccination rates and increased risk for possible paralytic disease . 5
Going forward , wastewater monitoring for polio will continue in the aforementioned communities and those with high international travel traffic . Travel paths are not often evident , and some countries use oral polio vaccine , which , although rare , can cause poliomyelitis . As a typically seasonal disease , 6
detections are expected to decrease significantly during the winter but preparedness for the following spring and summer is considered an important public health precaution .
Washington State Public Health Laboratories
In October 2022 , Washington State Department of Health ( DOH ) Public Health Laboratories ( PHL )
expanded its SARS-CoV-2 wastewater sampling and testing infrastructure to test for mpox as part of the Washington Wastewater-Based Epidemiology ( WAWBE )
program and DOH mpox response . Under the COVID-19 response , DOH PHL and WAWBE grew a sampling and analysis network of 15 wastewater treatment plants collecting samples twice weekly for SARS-CoV-2 analysis . Using this foundation , DOH leadership and the mpox response team identified wastewater surveillance as a priority mpox surveillance tool in Washington state . DOH PHL used a Stanford University presence / absence assay
to identify mpox in wastewater . The KingFisher™ Flex and Nanotrap ®
Microbiome A particles are used to concentrate the samples and DNA is extracted using the MagMax™ Viral / Pathogen Nucleic Acid Isolation Kit . This assay was quickly developed and validated with help from Washington ’ s Laboratory Response Network for Biological Threats ( LRN-B ) section and by using internal emergency use validation guidelines . The LRN-B section provided access to known positive material to ensure the primers and probes would be able to detect mpox and for use as spiking material for the validation study . A few challenges included a short validation timeline leading to only presence / absence testing and the inability to create a SARS-CoV-2 multiplex . Low
20 LAB MATTERS Spring 2023