ArticlePloS one2023
Wastewater monitoring for detection of public health markers during the COVID-19 pandemic: Near-source monitoring of schools in England over an academic year.
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 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- A Systematic Review of Methodological Approaches to SARS-CoV-2 Wastewater Surveillance.Viruses · 2026Pooled it
- Accounting for methodological variabilities in disease outbreak surveillance using wastewater-based epidemiology: a case study with SARS-CoV-2.Analytical and bioanalytical chemistry · 2026Article
- Validation of molecular detection ofMicrobiology spectrum · 2026Article
- Community-level wastewater influenza concentrations and school attendance in Jefferson County, Kentucky (2022-2025).Journal of water and health · 2026Article
- Near-source wastewater surveillance as a non-invasive tool for disease detection in prisons.Scientific reports · 2026Article
- Culture, qPCR, and genome-based surveillance ofFrontiers in microbiology · 2026Article
- Microbial innovations for sustainable water treatment.Sustainable microbiology · 2026Article
- Viral Metagenomic Next-Generation Sequencing for One Health Discovery and Surveillance of (Re)Emerging Viruses: A Deep Review.International journal of molecular sciences · 2025Review
- Performance and suitability of wastewater based-surveillance for SARS-CoV-2 RNA in public schools.Scientific reports · 2025Article
- Wastewater surveillance of SARS-CoV-2 from aircraft to citywide monitoring.Nature communications · 2025Article
- Wastewater Based Measures of COVID-19 and Associations with Children's Absenteeism at Grade Schools.The Science of the total environment · 2025Article
- Near-source wastewater surveillance of SARS-CoV-2, norovirus, influenza virus and RSV across five different sites in the UK.PLOS global public health · 2025Article
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- Campus source to sink wastewater surveillance of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).Current research in microbial sciences · 2024Article
- Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation.JMIR public health and surveillance · 2023Article
Corrections and comments
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Authors and funding
22 authors at 9 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSchools are high-risk settings for infectious disease transmission. Wastewater monitoring for infectious diseases has been used to identify and mitigate outbreaks in many near-source settings during the COVID-19 pandemic, including universities and hospitals but less is known about the technology when applied for school health protection. This study aimed to implement a wastewater surveillance system to detect SARS-CoV-2 and other public health markers from wastewater in schools in England.
methodsA total of 855 wastewater samples were collected from 16 schools (10 primary, 5 secondary and 1 post-16 and further education) over 10 months of school term time. Wastewater was analysed for SARS-CoV-2 genomic copies of N1 and E genes by RT-qPCR. A subset of wastewater samples was sent for genomic sequencing, enabling determination of the presence of SARS-CoV-2 and emergence of variant(s) contributing to COVID-19 infections within schools. In total, >280 microbial pathogens and >1200 AMR genes were screened using RT-qPCR and metagenomics to consider the utility of these additional targets to further inform on health threats within the schools.
resultsWe report on wastewater-based surveillance for COVID-19 within English primary, secondary and further education schools over a full academic year (October 2020 to July 2021). The highest positivity rate (80.4%) was observed in the week commencing 30th November 2020 during the emergence of the Alpha variant, indicating most schools contained people who were shedding the virus. There was high SARS-CoV-2 amplicon concentration (up to 9.2x106 GC/L) detected over the summer term (8th June - 6th July 2021) during Delta variant prevalence. The summer increase of SARS-CoV-2 in school wastewater was reflected in age-specific clinical COVID-19 cases. Alpha variant and Delta variant were identified in the wastewater by sequencing of samples collected from December to March and June to July, respectively. Lead/lag analysis between SARS-CoV-2 concentrations in school and WWTP data sets show a maximum correlation between the two-time series when school data are lagged by two weeks. Furthermore, wastewater sample enrichment coupled with metagenomic sequencing and rapid informatics enabled the detection of other clinically relevant viral and bacterial pathogens and AMR.
conclusionsPassive wastewater monitoring surveillance in schools can identify cases of COVID-19. Samples can be sequenced to monitor for emerging and current variants of concern at the resolution of school catchments. Wastewater based monitoring for SARS-CoV-2 is a useful tool for SARS-CoV-2 passive surveillance and could be applied for case identification and containment, and mitigation in schools and other congregate settings with high risks of transmission. Wastewater monitoring enables public health authorities to develop targeted prevention and education programmes for hygiene measures within undertested communities across a broad range of use cases.
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