Georgia WWSCAN Biweekly Newsletter Update 11/10/23

Welcome to the bi-weekly update for WWSCAN partners in Georgia! The samples provided up through 11/7/23 have been processed in the lab and data are on the site at data.wastewaterscan.org.

If you notice any bugs on the site or have any comments about it, please continue to send your feedback via email wwscan_stanford_emory@lists.stanford.edu. We thank you for your partnership!

The methods for our assays are in the public domain. You can access them using these QR codes:

WastewaterSCAN uses a Wastewater Categorization system to communicate insights from recent wastewater results. Research shows that the measurements we make in wastewater are related to disease in the community. The wastewater categorization helps us quickly understand if the recent measurements for a disease fall into a low, medium, or high category and are determined based on a combination of the following variables:

• Trends indicate whether wastewater concentrations of pathogens have been changing significantly (i.e., increasing or decreasing) for each location over the last 21 days
• Levels indicate whether wastewater concentrations are relatively lower or higher at each location compared to national concentrations of each pathogen (i.e., upper third, middle third, or lower third, as measured over the last year)
• Frequency of detection indicates how often a pathogen is detected in wastewater for each location over a recent time period (e.g., the last 10 days)

The new Wastewater Categorization system can now be accessed on the map view of the data.wastewaterscan.org site.

The Wastewater Categories are applied differently for three archetypes of diseases:

• Pathogens that are commonly detected (regardless of season) - SARS-CoV-2, Norovirus, and ‘peak season’ Respiratory pathogens (IAV, RSV, HMPV)

• Seasonal pathogens (rarely detected outside of season/outbreaks) - IAV, RSV, HMPV

The onset dates of IAV, RSV, and HMPV wastewater events are identified as the first day for which all samples in a 14 day look back period had concentrations higher than or equal to 2,000 copies/g, which is approximately twice the lowest detectable concentration. Once IAV, RSV, or HMPV are onset, the method for 'commonly detected pathogens' (see above) is used to determine the wastewater categorization.

The offset dates of IAV, RSV, and HMPV wastewater events were identified as the first day after an onset event for which only 50% of samples during a 14-d look back period have concentrations higher than or equal to 2,000 copies/g. When one of these signals is in offset, it is assign a ‘LOW’ categorization.

SARS-CoV-2 RNA concentrations have between 19,000 and 626,000 copies/gram in the last two weeks. The chart below shows the raw data since December 2022 and the population-weighted aggregated trend line for all 8 Georgia sites when the data is normalized by PMMoV. The aggregated line and the National Levels benchmarks illustrate that SARS-CoV-2 N gene RNA concentrations among Georgia sites are within the upper third level of all concentrations measured in the last year.

As of 11/10/23, Big Creek, Little River, South River and Utoy Creek are in the HIGH (4 sites) category; College Park, Columbus, and Johns Creek are in the MEDIUM (3 sites) category; RM Clayton is in the LOW (1 site) category.

Influenza A (IAV) RNA has been detected at at all Georgia sites within the last few weeks as seen in the heat map below. Concentrations are less than 12,000 copies/gram. As of 11/10/2023, there are 6 sites in the LOW Wastewater Category but Big Creek and College Park have had recent onsets of influenza A in wastewater and are in the HIGH (2 sites) Wastewater Category.

Influenza B (IBV) RNA continues to be most frequently detected in samples collected from the Columbus site. As seen in the heat map below, IBV RNA has been detected in the last two weeks in samples collected from College Park, South River, and Utoy Creek. Concentrations are below 13,000 copies/gram. As of 11/10/23, Columbus has had onset of influenza B in wastewater and is in the HIGH (1 site) Wastewater Category. Most sites are in the LOW (7 sites) category.

Respiratory syncytial virus (RSV) RNA concentrations range between 7,000 and 52,000 copies/gram across Georgia sites over the last two weeks. The chart below includes the raw data for each site since November 2022. The aggregated line and the National Levels benchmarks illustrate that RSV RNA concentrations among Georgia sites are within the upper third level of all concentrations measured in the last year. Most Georgia sites are in the HIGH (7 sites) Wastewater Category (in onset) as of 11/10/23; Utoy Creek is in the LOW (1 site) category. Recent aggregated levels are similar to last year's peak in RSV.

HMPV (human metapneumovirus) RNA detections are sporadic and occur at low concentrations. All 8 Georgia sites are in the LOW Wastewater Category based on sample collection through 11/10/23.

EV-D68 RNA has been detected at Columbus and Little River in the last two weeks, based on the heat map below. As a reminder, the color blue means the sample was non-detect for EV-D68 RNA and the colors get darker with higher concentrations. Because this is a new target, there is no category assigned and we are still establishing what an expected baseline amount of detection will be.

Parainfluenza RNA has been frequently detected in samples collected from most Georgia sites. Concentrations are less than 44,000 copies/g. Because this is a new target, there is no category assigned and we are still establishing what an expected baseline amount of detection will be.

Norovirus GII (HuNoV GII) RNA concentrations range between 1,400,000 - 16,000,000 copies/g and the population-weighted average line for the 8 Georgia sites is within the middle third level.

As of 11/10/2023, Big Creek, Johns Creek, Little River, and Utoy Creek are in the HIGH (4 sites) Wastewater Category; College Park, Columbus, RM Clayton, and South River are in the MEDIUM (4 sites) category.

Rotavirus RNA concentrations have been between 26,000 - 700,000 copies/g over the last two weeks. The chart below shows the population-weighted average line is shown in black plus the 5-sample trimmed lines for each site. Because this is a new target, there is no category assigned and we are still establishing what an expected baseline amount of detection will be.

Human Adenovirus Group F DNA concentrations range between 2,900,000 and 22,000,000 copies/g. Because this is a new target, there is no category assigned and we are still establishing what an expected baseline amount of detection will be.

Mpox DNA results have been non-detect at most sites in the last 21 days except at College Park, where there was a single detection on October 23rd, 2023. This heat map shows data since July 2022. Sites are labeled in the rows and each date a sample was collected as a column. The color blue means the sample was non-detect for mpox DNA and the color maroon means Mpox DNA was detected. White indicates no sample was collected. All 8 Georgia sites are in the LOW Wastewater Category as of 11/10/23.

Candida auris DNA has only been detected at the Columbus site within the last two weeks, based on the heat map below that dates back to 9/5/2023. Because this is a new target, there is no category assigned and we are still establishing what an expected baseline amount of detection will be.

Hepatitis A RNA detection is sporadic and has only been detected at RM Clayton over the last two weeks. Because this is a new target, there is no category assigned and we are still establishing what an expected baseline amount of detection will be.

The next stakeholder meeting will take place Friday, December 8th @ 12 PM EST. You can use this zoom link to join. Hope to see you there!