Georgia WWSCAN biweekly update 10/13/2023

Welcome to the bi-weekly update for WWSCAN partners in Georgia! The samples provided up through 10/12/23 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 Amanda Bidwell at albidwel@stanford.edu. We thank you for your partnership!

New pathogen results (for EVD68, Adenovirus group F, Rotavirus, Candida auris, and Hepatitis A) became available on the main data.wastewastescan.org site on Monday, Sept 25, 2023.

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 important 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! Categories are not assigned for the new targets recently added.

The Wastewater Categories are broken up into 3 archetypes for WWSCAN Pathogens:

• 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 methodology used to determine seasonal Onset vs Offset using raw target concentrations (not PMMoV Normalized) for individual sites is as follows:

- 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 assigned a ‘LOW’ categorization

• Pathogens that are not commonly detected (regardless of season) - Mpox

SARS-CoV-2 RNA concentrations are less than 360,000 copies per 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 middle third level of all concentrations measured in the last year.

As of 10/12/23, Big Creek, Camp Creek, Johns Creek, Little River, and South River are in the HIGH (5 sites) category, Utoy Creek and RM Clayton are in the MEDIUM (2 sites) category, and Columbus is in the LOW (1 site) category.

Influenza A (IAV) RNA has been detected at low concentrations at Big Creek, Columbus, and RM Clayton within the last two weeks as seen in the heat map below. This represents a higher rate of detection than in the last several months. Concentrations are less than 7500 copies/g. All 8 Georgia sites are in the LOW Wastewater Category (not in onset) based as of 10/12/23.

Influenza B (IBV) RNA continues to be rarely detected at most sites. It has been more frequently detected in samples collected from the Columbus site, where concentrations are below 4900 copies/g. All 8 Georgia sites are in the LOW Wastewater Category (not in onset) based as of 10/12/23.

Respiratory syncytial virus (RSV) RNA concentrations are less than 80,000 copies/g. The chart below includes the raw data for each site since July plus the population-weighted average line showing that RSV RNA concentrations among the 8 Georgia sites continue to be in the upper third level of all concentrations measured in the last year. This is because there are are many measurements that are non-detect for RSV throughout the year, so consistent detections quickly reach a higher level.

Most Georgia sites are in the LOW (5 sites) Wastewater Category (not in onset) as of 10/13/23; Camp Creek, Johns Creek and RM Clayton have had onset of RSV events and are in the HIGH (2 sites) category.

HMPV (human metapneumovirus) RNA detections are sporadic and concentrations are below 7200 copies/g. This represents a higher rate of detection than in the last several months. According to this heat map, HMPV has been more frequently detected in the last few weeks at most sites except RM Clayton, Columbus, and Little River. All 8 Georgia sites are in the LOW Wastewater Category based on sample collection through 10/12/23.

EV-D68 RNA has been detected at Big Creek and South 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 168,000 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 have increased to range between 352,000 - 14,270,000 copies/g and the population-weighted average line for the 8 Georgia sites is within the upper third level.

Most Georgia sites are in the MEDIUM (5 sites) Wastewater Category (Big Creek, College Park, RM Clayton, South River, and Utoy Creek) as of 10/12/23; Columbus and Johns Creek are in the HIGH (2 sites) category; and Little River is in the LOW (1 site) Wastewater Category. Norovirus in the south is currently higher than in other parts of the country.

Rotavirus RNA concentrations have been between 16,000 - 400,000 copies/g over the last two weeks. The chart below begins 09/05/2023 and 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 1,200,000 and 26,400,000 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 in the last 21 days at most Georgia plants except Utoy Creek, where a single detection occurred on 10/5/2023. 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 based on sample collection through 10/12/23.

Candida auris DNA has been detected at College Park and Columbus, based on the heat map below that dates back to 09/05/2023. 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 been detected at most sites except College Park, Johns Creek, and Utoy Creek. This heat map shows data since September 5th, 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.

The next stakeholder meeting will take place Friday, November 10th @ 12 PM EST.