ArticleNature communications2022
An analysis of 45 large-scale wastewater sites in England to estimate SARS-CoV-2 community prevalence.
Article in Nature communications, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers.
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Who cites it
44 citing papers in PubMed, 111 citations in OpenAlex.
- Recommendations for the analysis of leading indicators in epidemic surveillance.PLOS digital health · 2026Review
- Does plastic waste present an infection hazard? Current evidence, surveillance challenges and research priorities.One health outlook · 2026Review
- Seasonal forcing and waning immunity drive the sub-annual periodicity of the COVID-19 epidemic.PLoS pathogens · 2026Article
- Cost-Effective Sampling Strategies for Wastewater Surveillance: A Large-Scale Longitudinal Study in Hong Kong and Shenzhen.Environmental science & technology · 2026Article
- Environmental metagenomics enhances detection of circulating viruses from live poultry markets in Cambodia.Nature communications · 2026Article
- Clinical metagenomics for diagnosis and surveillance of viral pathogens.Nature reviews. Microbiology · 2026Review
- Evaluation of wastewater SARS-CoV-2 surveillance for monitoring COVID-19 trends and early warning in Sweden, 2023-2024.PloS one · 2026Article
- Evaluation and estimation of epidemic trajectories for SARS-CoV-2 from clinical and wastewater data in Gauteng Province, South Africa.PLOS global public health · 2026Article
- Wastewater-based epidemiology reveals spatiotemporal dynamics and diurnal temperature range effects on post-pandemic SARS-CoV-2 infection burden in Chongqing, China.Frontiers in public health · 2026Article
- Wastewater-based epidemiology of influenza A virus in Shenzhen: baseline values and implications for multi-pathogen surveillance.Emerging microbes & infections · 2025Article
- The potential of wastewater monitoring as a novel surveillance tool for early warning ofEmerging microbes & infections · 2025Article
- Inclusion of Physical-Chemical Water Quality Measurements Can Improve Associations between SARS-CoV-2 RNA Levels in Wastewater and COVID-19 Cases within Smaller Sewersheds.Journal of environmental engineering (New York, N.Y.) · 2025Article
- Air, surface, and wastewater surveillance of SARS-CoV-2; a multimodal evaluation of COVID-19 detection in a built environment.Journal of exposure science & environmental epidemiology · 2025Article
- Determining genotype and antimicrobial resistance of Salmonella Typhi in environmental samples by amplicon sequencing.PLoS neglected tropical diseases · 2025Article
- Evaluation of wastewater percent positive for assessing epidemic trends - A case study of COVID-19 in Shangrao, China.Infectious Disease Modelling · 2025Article
- The Impact of Viral Concentration Method on Quantification and Long Amplicon Nanopore Sequencing of SARS-CoV-2 and Noroviruses in Wastewater.Microorganisms · 2025Article
- The impact of signal variability on COVID-19 epidemic growth rate estimation from wastewater surveillance data.PloS one · 2025Article
- Detection of SARS-CoV-2 in wastewater as an earlier predictor of COVID-19 epidemic peaks in Venezuela.Scientific reports · 2024Article
- Unveiling the silent information of wastewater-based epidemiology of SARS-CoV-2 at community and sanitary zone levels: experience in Córdoba City, Argentina.Journal of water and health · 2024Article
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Corrections and comments
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Authors and funding
16 authors at 6 institutions in 1 country.
Funding
Abstract
Accurate surveillance of the COVID-19 pandemic can be weakened by under-reporting of cases, particularly due to asymptomatic or pre-symptomatic infections, resulting in bias. Quantification of SARS-CoV-2 RNA in wastewater can be used to infer infection prevalence, but uncertainty in sensitivity and considerable variability has meant that accurate measurement remains elusive. Here, we use data from 45 sewage sites in England, covering 31% of the population, and estimate SARS-CoV-2 prevalence to within 1.1% of estimates from representative prevalence surveys (with 95% confidence). Using machine learning and phenomenological models, we show that differences between sampled sites, particularly the wastewater flow rate, influence prevalence estimation and require careful interpretation. We find that SARS-CoV-2 signals in wastewater appear 4-5 days earlier in comparison to clinical testing data but are coincident with prevalence surveys suggesting that wastewater surveillance can be a leading indicator for symptomatic viral infections. Surveillance for viruses in wastewater complements and strengthens clinical surveillance, with significant implications for public health.
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