ArticleBMC public health2023
Evaluation of the pilot wastewater surveillance for SARS-CoV-2 in Norway, June 2022 - March 2023.
Article in BMC public health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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12 citing papers in PubMed.
- Influence of Sampling Strategies and Disease Prevalence on SARS-CoV-2 Detection Dynamics in Wastewater Surveillance.Viruses · 2026Article
- Evaluation of wastewater SARS-CoV-2 surveillance for monitoring COVID-19 trends and early warning in Sweden, 2023-2024.PloS one · 2026Article
- A framework for evaluating implementation, impact, and cost-effectiveness of wastewater and environmental surveillance.Frontiers in public health · 2026Review
- Pepper mild mottle virus as a potential indicator of occupational exposure to airborne viruses in wastewater treatment plants.Annals of work exposures and health · 2025Article
- Unsupervised detection of novel SARS-CoV-2 mutations and lineages in wastewater samples using long-read sequencing.BMC genomics · 2025Article
- Estimating the trend of COVID-19 in Norway by combining multiple surveillance indicators.PloS one · 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
- Wastewater Surveillance of SARS-CoV-2 in Zambia: An Early Warning Tool.International journal of molecular sciences · 2024Article
- A survey of the representativeness and usefulness of wastewater-based surveillance systems in 10 countries across Europe in 2023.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2024Article
- Online dashboards for SARS-CoV-2 wastewater-based epidemiology.Future microbiology · 2024Review
- Effect of testing criteria for infectious disease surveillance: The case of COVID-19 in Norway.PloS one · 2024Article
- Evaluation of wastewater surveillance for SARS-CoV-2 in a prison population: a mixed-methods approach.Frontiers in public health · 2024Article
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Authors and funding
12 authors.
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Abstract
backgroundDuring the COVID-19 pandemic, wastewater-based surveillance gained great international interest as an additional tool to monitor SARS-CoV-2. In autumn 2021, the Norwegian Institute of Public Health decided to pilot a national wastewater surveillance (WWS) system for SARS-CoV-2 and its variants between June 2022 and March 2023. We evaluated the system to assess if it met its objectives and its attribute-based performance.
methodsWe adapted the available guidelines for evaluation of surveillance systems. The evaluation was carried out as a descriptive analysis and consisted of the following three steps: (i) description of the WWS system, (ii) identification of users and stakeholders, and (iii) analysis of the system's attributes and performance including sensitivity, specificity, timeliness, usefulness, representativeness, simplicity, flexibility, stability, and communication. Cross-correlation analysis was performed to assess the system's ability to provide early warning signal of new wave of infections.
resultsThe pilot WWS system was a national surveillance system using existing wastewater infrastructures from the largest Norwegian municipalities. We found that the system was sensitive, timely, useful, representative, simple, flexible, acceptable, and stable to follow the general trend of infection. Preliminary results indicate that the system could provide an early signal of changes in variant distribution. However, challenges may arise with: (i) specificity due to temporary fluctuations of RNA levels in wastewater, (ii) representativeness when downscaling, and (iii) flexibility and acceptability when upscaling the system due to limited resources and/or capacity.
conclusionsOur results showed that the pilot WWS system met most of its surveillance objectives. The system was able to provide an early warning signal of 1-2 weeks, and the system was useful to monitor infections at population level and complement routine surveillance when individual testing activity was low. However, temporary fluctuations of WWS values need to be carefully interpreted. To improve quality and efficiency, we recommend to standardise and validate methods for assessing trends of new waves of infection and variants, evaluate the WWS system using a longer operational period particularly for new variants, and conduct prevalence studies in the population to calibrate the system and improve data interpretation.
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