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dc.contributor.authorMonteiro, Sílvia
dc.contributor.authorRente, Daniela
dc.contributor.authorCunha, Mónica V.
dc.contributor.authorGomes, Manuel Carmo
dc.contributor.authorMarques, Tiago A.
dc.contributor.authorLourenço, Artur B.
dc.contributor.authorCardoso, Eugénia
dc.contributor.authorÁlvaro, Pedro
dc.contributor.authorSilva, Marco
dc.contributor.authorCoelho, Norberta
dc.contributor.authorVilaça, João
dc.contributor.authorMeireles, Fátima
dc.contributor.authorBrôco, Nuno
dc.contributor.authorCarvalho, Marta
dc.contributor.authorSantos, Ricardo
dc.identifier.citationMonteiro , S , Rente , D , Cunha , M V , Gomes , M C , Marques , T A , Lourenço , A B , Cardoso , E , Álvaro , P , Silva , M , Coelho , N , Vilaça , J , Meireles , F , Brôco , N , Carvalho , M & Santos , R 2022 , ' A wastewater-based epidemiology tool for COVID-19 surveillance in Portugal ' , Science of the Total Environment , vol. 804 , 150264 .
dc.identifier.otherPURE: 275869804
dc.identifier.otherPURE UUID: 9abccadb-e431-4ac0-81fd-1f4912abdf6c
dc.identifier.otherRIS: urn:6FE2064D16EA8DD5CE7354799AC1E218
dc.identifier.otherORCID: /0000-0002-2581-1972/work/100172365
dc.identifier.otherScopus: 85114825840
dc.identifier.otherWOS: 000704389800014
dc.descriptionFunding: Strategic funding of Fundação para a Ciência e a Tecnologia (FCT), Portugal, to cE3c and BioISI Research Units ( UIDB/00329/2020 and UIDB/04046/2020 ] is also gratefully acknowledged. This work was supported by Programa Operacional de Competitividade e Internacionalização (POCI) (FEDER component), Programa Operacional Regional de Lisboa , and Programa Operacional Regional do Norte (Project COVIDETECT, ref. 048467 ).en
dc.description.abstractThe presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in wastewater produced interest in its use for sentinel surveillance at a community level and as a complementary approach to syndromic surveillance. With this work, we set the foundations for wastewater-based epidemiology (WBE) in Portugal by monitoring the trends of SARS-CoV-2 RNA circulation in the community, on a nationwide perspective during different epidemiological phases of the pandemic. The Charité assays (E_Sarbecco, RdRP, and N_Sarbecco) were applied to monitor, over 32-weeks (April to December 2020), the dynamics of SARS-CoV-2 RNA at the inlet of five wastewater treatment plants (WWTP), which together serve more than two million people in Portugal. Raw wastewater from three Coronavirus disease 2019 (COVID-19) reference hospitals was also analyzed during this period. In total, more than 600 samples were tested. For the first weeks, detection of SARS-CoV-2 RNA was sporadic, with concentrations varying from 103 to 105 genome copies per liter (GC/L). Prevalence of SARS-CoV-2 RNA increased steeply by the end of May into late June, mainly in Lisboa e Vale do Tejo region (LVT), during the reopening phase. After the summer, with the reopening of schools in mid-September and return to partial face-to-face work, a pronounced increase of SARS-CoV-2 RNA in wastewater was detected. In the LVT area, SARS-CoV-2 RNA load agreed with reported trends in hotspots of infection. Synchrony between trends of SARS-CoV-2 RNA in raw wastewater and daily new COVID-19 cases highlights the value of WBE as a surveillance tool, particularly after the phasing out of the epidemiological curve and when hotspots of disease re-emerge in the population which might be difficult to spot based solely on syndromic surveillance and contact tracing. This is the first study crossing several epidemiological stages highlighting the long-term use of WBE for SARS-CoV-2.
dc.relation.ispartofScience of the Total Environmenten
dc.rightsCopyright © 2021 Elsevier B.V. All rights reserved. This work has been made available online in accordance with publisher policies or with permission. Permission for further reuse of this content should be sought from the publisher or the rights holder. This is the author created accepted manuscript following peer review and may differ slightly from the final published version. The final published version of this work is available at
dc.subjectWastewater-based epidemiologyen
dc.subjectHospital wastewateren
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.subjectTD Environmental technology. Sanitary engineeringen
dc.subjectEnvironmental Chemistryen
dc.subjectEnvironmental Engineeringen
dc.subjectWaste Management and Disposalen
dc.titleA wastewater-based epidemiology tool for COVID-19 surveillance in Portugalen
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Mathematics and Statisticsen
dc.contributor.institutionUniversity of St Andrews. Scottish Oceans Instituteen
dc.contributor.institutionUniversity of St Andrews. Centre for Research into Ecological & Environmental Modellingen
dc.description.statusPeer revieweden

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