Wastewater-based Epidemiology: An Approach for Evaluating the Behavioral and Health Status of the Community Through Wastewater Sample Analysis

Document Type : Review Article

Authors

1 MSc, Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

2 PhD Candidate, Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

10.48305/jims.v43.i820.0728

Abstract

Background: The increased consumption of pharmaceuticals and chemicals, changes in infectious disease patterns, and the emergence of novel diseases have raised public health concerns. Wastewater-based epidemiology (WBE) enables the extraction of epidemiological information related to lifestyle, health/disease status, and exposure to chemical agents within the target population through wastewater analysis. This study aimed to explore the applications of WBE and identify its challenges.
Methods: This study reviewed articles on WBE from three databases (PubMed, Science Direct, and Scopus) and the Google Scholar search engine.
Findings: The results showed that chemical and microbial analysis of wastewater can provide extensive epidemiological information, both spatially and temporally, on the behavioral and health status of the target population. These data include indicators such as the use of illicit drugs, alcohol, and tobacco, the consumption of over-the-counter medications, and the burden of viral diseases, particularly the novel coronavirus, within the population covered by the wastewater network.
Conclusion: WBE serves as a powerful tool linking environmental sciences, public health, and epidemiology. The findings obtained through this approach provide valuable information for policymakers and public health authorities, aiding in informed decision-making for improving public health and controlling diseases. However, the application of this approach faces challenges, such as markers instability in wastewater, non-human sources of infectious agents, and the lack of standard sampling and analysis protocols in many cases.

Highlights

Sahar Gholipour: Google Scholar

Mahnaz Nikaeen: Google Scholar

Keywords

References

  1. Robins K, Leonard AFC, Farkas K, Graham DW, Jones DL, Kasprzyk-Hordern B, et al. Research needs for optimising wastewater-based epidemiology monitoring for public health protection. J Water Health 2022; 20(9): 1284–313.
  2. Singer AC, Thompson JR, Filho CRM, Street R, Li X, Castiglioni S, et al. A world of wastewater-based epidemiology. Nat Water 2023; 1(5): 408–15.
  3. Castiglioni S, Bijlsma L, Covaci A, Emke E, Hernández F, Reid M, et al. Evaluation of uncertainties associated with the determination of community drug use through the measurement of sewage drug biomarkers. Environ Sci Technol 2013; 47(3): 1452–60.
  4. Guidelines for environmental surveillance of poliovirus circulation. Geneva, Switzerland: World Health Organization; 2003.
  5. Gwenzi W, Adelodun B, Kumar P, Ajibade FO, Silva LFO, Choi KS, et al. Human viral pathogens in the wastewater-source water-drinking water continuum: Evidence, health risks, and lessons for future outbreaks in low-income settings. Sci Total Environ 2024; 918: 170214.
  6. Nutt D, King LA, Saulsbury W, Blakemore C. Development of a rational scale to assess the harm of drugs of potential misuse. Lancet 2007; 369(9566): 1047–53.
  7. Li X, Du P, Zhang W. Application of wastewater-based epidemiology in China—from wastewater monitoring to drug control efforts. In: Wastewater-Based Epidemiology: Estimation of Community Consumption of Drugs and Diets. ACS Publications; 2019. p. 119–35.
  8. Lai FY, O’Brien JW, Thai PK, Hall W, Chan G, Bruno R, et al. Cocaine, MDMA and methamphetamine residues in wastewater: Consumption trends (2009–2015) in South East Queensland, Australia. Sci Total Environ 2016; 568: 803–9.
  9. Bishop N, Jones-Lepp T, Margetts M, Sykes J, Alvarez D, Keil DE. Wastewater-based epidemiology pilot study to examine drug use in the Western United States. Sci Total Environ. 2020;745:140697.
  10. Yargeau V, Taylor B, Li H, Rodayan A, Metcalfe CD. Analysis of drugs of abuse in wastewater from two Canadian cities. Sci Total Environ 2014; 487: 722–30.
  11. Pacheco FA. Illicit drugs in wastewater treatment plants utilization of wastewater-based epidemiology in a Brazilian regional city. World J Adv Res Rev 2020; 6(1): 6–18.
  12. Commandeur JJF, Vujic S, Koopman SJ, Kasprzyk-Hordern B. Temporal, Spatial, Economic and Crime Factors in Illicit Drug Usage across European Cities. Tinbergen Institute Discussion Paper; 2014.
  13. Humphries MA, Bruno R, Lai FY, Thai PK, Holland BR, O’Brien JW, et al. Evaluation of monitoring schemes for wastewater-based epidemiology to identify drug use trends using cocaine, methamphetamine, MDMA and methadone. Environ Sci Technol 2016; 50(9): 4760–8.
  14. van Dyken E, Thai P, Lai FY, Ort C, Prichard J, Bruno R, et al. Monitoring substance use in prisons: Assessing the potential value of wastewater analysis. Sci Justice 2014; 54(5): 338–45.
  15. Castiglioni S, Borsotti A, Senta I, Zuccato E. Wastewater analysis to monitor spatial and temporal patterns of use of two synthetic recreational drugs, ketamine and mephedrone, in Italy. Environ Sci Technol 2015; 49(9): 5563–70.
  16. Du P, Zhou Z, Bai Y, Xu Z, Gao T, Fu X, et al. Estimating heroin abuse in major Chinese cities through wastewater-based epidemiology. Sci Total Environ 2017; 605: 158–65.
  17. Rice J, Kannan AM, Castrignanò E, Jagadeesan K, Kasprzyk-Hordern B. Wastewater-based epidemiology combined with local prescription analysis as a tool for temporalmonitoring of drugs trends-A UK perspective. Sci Total Environ 2020; 735: 139433.
  18. González-Mariño I, Gracia-Lor E, Rousis NI, Castrignano E, Thomas KV, Quintana JB, et al. Wastewater-based epidemiology to monitor synthetic cathinones use in different European countries. Environ Sci Technol 2016; 50(18): 10089–96.
  19. Brandeburová P, Bodík I, Horáková I, Žabka D, Castiglioni S, Salgueiro-González N, et al. Wastewater-based epidemiology to assess the occurrence of new psychoactive substances and alcohol consumption in Slovakia. Ecotoxicol Environ Saf 2020; 200: 110762.
  20. Chen Y-C, Hsu J-Y, Chang C-W, Chen P-Y, Lin Y-C, Hsu I-L, et al. Investigation of new psychoactive substances (NPS), other illicit drugs, and drug-related compounds in a Taiwanese wastewater sample using high-resolution mass-spectrometry-based targeted and suspect screening. Molecules 2023; 28(13): 5040.
  21. Shin C, Kim Y-K. Ketamine in major depressive disorder: mechanisms and future perspectives. Psychiatry Investig 2020; 17(3): 181.
  22. Lu H, Fan J, Guo C, Yang J, Zhang H, Chen M, et al. Estimating the prevalence of depression using wastewater-based epidemiology: A case study in Qinghai Province, West China. Sci Total Environ 2023; 882: 163303.
  23. Metcalfe CD, Chu S, Judt C, Li H, Oakes KD, Servos MR, et al. Antidepressants and their metabolites in municipal wastewater, and downstream exposure in an urban watershed. Environ Toxicol Chem 2010; 29(1): 79–89.
  24. Gushgari AJ, Venkatesan AK, Chen J, Steele JC, Halden RU. Long-term tracking of opioid consumption in two United States cities using wastewater-based epidemiology approach. Water Res 2019; 161: 171–80.
  25. Jaunay EL, Simpson BS, White JM, Gerber C. Using wastewater-based epidemiology to evaluate the relative scale of use of opioids. Sci Total Environ 2023; 897: 165148.
  26. Casas ME, Schröter NS, Zammit I, Castaño-Trias M, Rodriguez-Mozaz S, Gago-Ferrero P, et al. Showcasing the potential of wastewater-based epidemiology to track pharmaceuticals consumption in cities: comparison against prescription data collected at fine spatial resolution. Environ Int 2021; 150: 106404.
  27. Driver EM, Gushgari A, Chen J, Halden RU. Alcohol, nicotine, and caffeine consumption on a public US university campus determined by wastewater-based epidemiology. Sci Total Environ 2020; 727: 138492.
  28. Wilson MK, Phung K, Chappell A, Pilkington LI. Wastewater‐based epidemiology to investigate spatio‐temporal trends in alcohol consumption in Aotearoa, New Zealand. Chem Asian J 2024; 19(6): e202301120.
  29. Jones CM, Paulozzi LJ, Mack KA, (CDC) C for DC and P. Alcohol involvement in opioid pain reliever and benzodiazepine drug abuse-related emergency department visits and drug-related deaths-United States, 2010. MMWR Morb Mortal Wkly Rep 2014; 63(40): 881–5.
  30. Sousa JCG, Ribeiro AR, Barbosa MO, Pereira MFR, Silva AMT. A review on environmental monitoring of water organic pollutants identified by EU guidelines. J Hazard Mater 2018; 344: 146–62.
  31. Tudi M, Li H, Li H, Wang L, Lyu J, Yang L, et al. Exposure routes and health risks associated with pesticide application. Toxics 2022; 10(6): 335.
  32. González-Mariño I, Rodil R, Barrio I, Cela R, Quintana JB. Wastewater-based epidemiology as a new tool for estimating population exposure to phthalate plasticizers. Environ Sci Technol 2017; 51(7): 3902–10.
  33. Arabzadeh R, Grünbacher DM, Insam H, Kreuzinger N, Markt R, Rauch W. Data filtering methods for SARS-CoV-2 wastewater surveillance. Water Sci Technol 2021; 84(6): 1324–39.
  34. Cardenes I, Hall JW, Eyre N, Majid A, Jarvis S. Quantifying the energy consumption and greenhouse gas emissions of changing wastewater quality standards. Water Sci Technol 2020; 81(6): 1283–95.
  35. Swain MJ, Carter B, Snowdon K, Faust RA. The implementation and utilization of wastewater-based epidemiology: experiences from a local health department. J Public Heal Manag Pract 2023; 29(3): 322–5.
  36. Laimou-Geraniou M, Heath D, Heath E. Analytical methods for the determination of antidepressants, antipsychotics, benzodiazepines and their metabolites through wastewater-based epidemiology. Trends Environ Anal Chem 2023; 37: e00192.
  37. de Lourdes Aguiar-Oliveira M, Campos A, Matos AR, Rigotto C, Sotero-Martins A, Teixeira PFP, et al. Wastewater-based epidemiology (Wbe) and viral detection in polluted surface water: A valuable tool for covid-19 surveillance—a brief review. Int J Environ Res Public Health 2020; 17(24): 9251.
  38. Mao K, Zhang H, Pan Y, Yang Z. Biosensors for wastewater-based epidemiology for monitoring public health. Water Res 2021; 191: 116787.
  39. Zahedi A, Monis P, Deere D, Ryan U. Wastewater-based epidemiology—surveillance and early detection of waterborne pathogens with a focus on SARS-CoV-2, Cryptosporidium and Giardia. Parasitol Res 2021; 120(12): 4167–88.
  40. Elahi E, Zhang L, Abid M, Javed MT, Xinru H. Direct and indirect effects of wastewater use and herd environment on the occurrence of animal diseases and animal health in Pakistan. Environ Sci Pollut Res 2017; 24(7): 6819–32.
  41. Dharmadhikari T, Yadav R, Dastager S, Dharne M. Translating SARS-CoV-2 wastewater-based epidemiology for prioritizing mass vaccination: a strategic overview. Environ Sci Pollut Res 2021; 28(31): 42975–80.
  42. Gholipour S, Hosseini M, Nikaeen M, Hadi M, Sarmadi M, Saderi H, et al. Quantification of human adenovirus in irrigation water-soil-crop continuum: are consumers of wastewater-irrigated vegetables at risk? Environ Sci Pollut Res 2022; 29(36): 54561-70.
  43. Xagoraraki I, O’Brien E. Wastewater-based epidemiology for early detection of viral outbreaks. Women water Qual 2019; 75–97.
  44. Lago PM, Gary Jr HE, Pérez LS, Cáceres V, Olivera JB, Puentes RP, et al. Poliovirus detection in wastewater and stools following an immunization campaign in Havana, Cuba. Int J Epidemiol 2003; 32(5): 772–7.
  45. Gholipour S, Ghalhari MR, Nikaeen M, Rabbani D, Pakzad P, Miranzadeh MB. Occurrence of viruses in sewage sludge: A systematic review. Sci Total Environ 2022; 824: 153886.
  46. Gholipour S, Rabbani D, Nikaeen M. Presence of coronavirus, enterovirus and adenovirus in municipal wastewater as indicators of the prevalence of associated viral infections in the community [in Persian]. J Maz Univ Med Sci 2021; 31(197): 44–54.
  47. Gholipour S, Mohammadi F, Nikaeen M, Shamsizadeh Z, Khazeni A, Sahbaei Z, et al. COVID-19 infection risk from exposure to aerosols of wastewater treatment plants. Chemosphere 2021; 273: 129701.
  48. Prado T, Fumian TM, Mannarino CF, Resende PC, Motta FC, Eppinghaus ALF, et al. Wastewater-based epidemiology as a useful tool to track SARS-CoV-2 and support public health policies at municipal level in Brazil. Water Res 2021; 191: 116810.
  49. Perez-Zabaleta M, Archer A, Khatami K, Jafferali MH, Nandy P, Atasoy M, et al. Long-term SARS-CoV-2 surveillance in the wastewater of Stockholm: What lessons can be learned from the Swedish perspective? Sci Total Environ 2023; 858: 160023.
  50. Gholipour S, Shamsizadeh Z, Gwenzi W, Nikaeen M. The bacterial biofilm resistome in drinking water distribution systems: A systematic review. Chemosphere 2023; 329: 138642.
  51. Gholipour S, Nikaeen M, Mohammadi F, Rabbani D. Antibiotic resistance pattern of waterborne causative agents of healthcare-associated infections: A call for biofilm control in hospital water systems. J Infect Public Health 2024; 17(7): 102469.
  52. Gholipour S, Shamsizadeh Z, Halabowski D, Gwenzi W, Nikaeen M. Combating antibiotic resistance using wastewater surveillance: Significance, applications, challenges, and future directions. Sci Total Environ 2024; 908: 168056.
  53. Bowes DA, Driver EM, Halden RU. A framework for wastewater sample collection from a sewage cleanout to inform building-scale wastewater-based epidemiology studies. Sci Total Environ 2022; 836: 155576.
  54. Katayama YA, Hayase S, Ando Y, Kuroita T, Okada K, Iwamoto R, et al. COPMAN: A novel high-throughput and highly sensitive method to detect viral nucleic acids including SARS-CoV-2 RNA in wastewater. Sci Total Environ 2023; 856(Pt 1): 158966.
  55. Chen C, Wang Y, Kaur G, Adiga A, Espinoza B, Venkatramanan S, et al. Wastewater-based Epidemiology for COVID-19 Surveillance and Beyond: A Survey. ArXiv 2024; arXiv-2403.
  56. Saleem MH, Mfarrej MFB, Khan KA, Alharthy SA. Emerging trends in wastewater treatment: Addressing microorganic pollutants and environmental impacts. Sci Total Environ 2024; 913: 169755.
  57. Sims N, Kasprzyk-hordern B. Future perspectives of wastewater-based epidemiology : Monitoring infectious disease spread and resistance to the community level. Environ Int 2020; 139: 105689.
  58. Choi PM, Tscharke BJ, Donner E, Brien JWO, Grant SC, Kaserzon SL, et al. Trends in Analytical Chemistry Wastewater-based epidemiology biomarkers : Past , present and future. Trends Anal Chem 2018; 105: 453–69.
  59. Lorenzo M, Picó Y. Wastewater-based epidemiology: current status and future prospects. Curr Opin Environ Sci Heal 2019; 9: 77–84.
Journal of Isfahan Medical School
Volume 43, Issue 820
4th Week, August
July and August 2025
Pages 728-742

Files

History

  • Receive Date: 05 October 2024
  • Accept Date: 26 May 2025

Share

How to cite

Statistics