ArticlePloS one2023
A multistate assessment of population normalization factors for wastewater-based epidemiology of COVID-19.
Article in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.
- A Systematic Review of Methodological Approaches to SARS-CoV-2 Wastewater Surveillance.Viruses · 2026Pooled it
- Coupled epidemiological and wastewater modeling at the urban scale: A case study for Munich.iScience · 2026Article
- Comparative analysis of wastewater sample processing methods for antimicrobial resistance surveillance.Microbiology spectrum · 2026Article
- First Wastewater-Based Surveillance of Tomato Brown Rugose Fruit Virus (ToBRFV) in Korea.Food and environmental virology · 2026Article
- Assessing long-term specific pollutant loads in municipal wastewater plants influent using monitoring data: A case study from Latvia.Journal of water and health · 2026Article
- Variability analysis of a low-cost paper dipstick nucleic acid extraction method for wastewater surveillance using gage repeatability and reproducibility.Scientific reports · 2026Article
- Estimating wastewater concentrations of norovirus and rotavirus from global data on community-level infection prevalence and viral shedding.Journal of water and health · 2026Article
- Near-Source Wastewater Surveillance of SARS-CoV-2, Influenza A, and Respiratory Syncytial Virus With Spatiotemporal Evaluation of Pepper Mild Mottle Virus as a Fecal Indicator.Water environment research : a research publication of the Water Environment Federation · 2026Article
- Spatially Informed Wastewater Differentiation among Locations during an Ongoing Measles Outbreak in Texas, USA.ACS environmental Au · 2025Article
- Long-Term Genomic Surveillance of SARS-CoV‑2 in Campus Wastewater Depicts Lineage Trends and Public Health Implications during and after Omicron Waves.Environment & health (Washington, D.C.) · 2025Article
- Norovirus trends in British Columbia from 2021 to 2022: the relationship between wastewater surveillance and clinical outbreak data during the COVID-19 pandemic.Scientific reports · 2025Article
- Comparative Assessment of Wastewater-Based Surveillance Normalization Methods to Improve Pathogen Monitoring in Rural Sewersheds.Environmental science & technology · 2025Article
- Article
- Evaluating small extracellular vesicle-based vaccination across heterologousInfection and immunity · 2025Article
- Wastewater-Based Epidemiological Surveillance in France: The SUM'EAU Network.Microorganisms · 2025Article
- Environmental Dissemination of SARS-CoV-2: An Analysis Employing Crassphage and Next-Generation Sequencing Protocols.Food and environmental virology · 2025Article
- Estimating rates of change to interpret quantitative wastewater surveillance of disease trends.The Science of the total environment · 2024Article
- Article
- Critical Needs for Integrated Surveillance: Wastewater-Based and Clinical Epidemiology in Evolving Scenarios with Lessons Learned from SARS-CoV-2.Food and environmental virology · 2024Article
- Correlation of wastewater surveillance data with traditional influenza surveillance measures in Cook County, Illinois, October 2022-April 2023.The Science of the total environment · 2024Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
Wastewater-based epidemiology (WBE) has become a valuable tool for monitoring SARS-CoV-2 infection trends throughout the COVID-19 pandemic. Population biomarkers that measure the relative human fecal contribution to normalize SARS-CoV-2 wastewater concentrations are needed for improved analysis and interpretation of community infection trends. The Centers for Disease Control and Prevention National Wastewater Surveillance System (CDC NWSS) recommends using the wastewater flow rate or human fecal indicators as population normalization factors. However, there is no consensus on which normalization factor performs best. In this study, we provided the first multistate assessment of the effects of flow rate and human fecal indicators (crAssphage, F+ Coliphage, and PMMoV) on the correlation of SARS-CoV-2 wastewater concentrations and COVID-19 cases using the CDC NWSS dataset of 182 communities across six U.S. states. Flow normalized SARS-CoV-2 wastewater concentrations produced the strongest correlation with COVID-19 cases. The correlation from the three human fecal indicators were significantly lower than flow rate. Additionally, using reverse transcription droplet digital polymerase chain reaction (RT-ddPCR) significantly improved correlation values over samples that were analyzed with real-time reverse transcription quantitative polymerase chain reaction (rRT-qPCR). Our assessment shows that utilizing flow normalization with RT-ddPCR generate the strongest correlation between SARS-CoV-2 wastewater concentrations and COVID-19 cases.
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