Research Articles

The Lavatory Lens: Tracking the Global Movement of Pathogens via Aircraft Wastewater

Bivins, A.; Morfino, R.; Franklin, A.; Simpson, S.; Ahmed, W. The Lavatory Lens: Tracking the Global Movement of Pathogens via Aircraft Wastewater. 2023, 2023050587.

During the COVID-19 pandemic, public health agencies used multi-layered control strategies including pre-departure testing and vaccination requirements, masking, post-arrival testing, and quarantine to manage the risk of COVID-19 transmission associated with air travel. Simultaneously, the surveillance of aircraft wastewater emerged as a promising new data source to screen for SARS-CoV-2 infections, including newly emergent lineages, among international air travelers. Herein, we review the potential of aircraft wastewater for public health surveillance. The known contributing population and flight itinerary combined with the highly concentrated waste stream and convenient sampling during routine lavatory servicing make aircraft wastewater a strategic opportunity for unintrusive surveillance of the global fluxes of human pathogens.

Notes from the Field: Aircraft Wastewater Surveillance for Early Detection of SARS-CoV-2 Variants — John F. Kennedy International Airport, New York City, August–September 2022

Morfino RC, Bart SM, Franklin A, et al. Notes from the Field: Aircraft Wastewater Surveillance for Early Detection of SARS-CoV-2 Variants — John F. Kennedy International Airport, New York City, August–September 2022. MMWR Morb Mortal Wkly Rep 2023;72:210–211. 

During August 1–September 9, 2022, the biotech company Ginkgo Bioworks, in collaboration with CDC, evaluated the feasibility of SARS-CoV-2 variant detection in aircraft wastewater from incoming international flights. Aircraft wastewater samples were collected from selected flights from the United Kingdom, Netherlands, and France arriving at John F. Kennedy International Airport in New York City. Wastewater (approximately 0.25 gal [1 L]) was collected from each plane during normal maintenance using a device that attaches to the lavatory service panel port and the lavatory service truck hose.

Early Detection of Severe Acute Respiratory Syndrome Coronavirus 2 Variants Using Traveler-based Genomic Surveillance at 4 US Airports, September 2021–January 2022

Renee D Wegrzyn, Grace D Appiah, Robert Morfino, Scott R Milford, Allison Taylor Walker, Ezra T Ernst, William W Darrow, Siyao Lisa Li, Keith Robison, Duncan MacCannell, Dongjuan Dai, Brintha P Girinathan, Allison L Hicks, Bryan Cosca, Gabrielle Woronoff, Alex M Plocik, Birgitte B Simen, Leah Moriarty, Sarah Anne J Guagliardo, Martin S Cetron, Cindy R Friedman

Clinical Infectious Diseases, Volume 76, Issue 3, 1 February 2023, Pages e540–e543.

We enrolled arriving international air travelers in a SARS-CoV-2 genomic surveillance program. We used molecular testing of pooled nasal swabs and sequenced positive samples for sublineage. Traveler-based surveillance provided early-warning variant detection, reporting the first US Omicron BA.2 and BA.3 in North America.

Wastewater monitoring of SARS-CoV-2 RNA at K-12 schools: Comparison to pooled clinical testing data

Sooyeol Kim and Alexandria B. Boehm. 2023. PeerJ 11:e15079

The Concentric by Ginkgo team collaborated with researchers at Stanford university to investigate whether wastewater surveillance can be an attractive supplement to clinical testing in K-12 schools where individuals only spend a portion of their time but interact with others in close proximity, increasing risk of potential transmission of disease. Wastewater samples were collected from two K-12 schools in California and divided into solid and liquid fractions to be processed for detection of SARS-CoV-2. The resulting detection rate in each wastewater fraction was compared to each other and the detection rate in pooled clinical specimens.

Effect of Predeparture Testing on Postarrival SARS-CoV-2–Positive Test Results Among International Travelers — CDC Traveler-Based Genomic Surveillance Program, Four U.S. Airports, March–September 2022

Stephen M. Bart, PhD; Teresa C. Smith, MPH; Sarah Anne J. Guagliardo, PhD; Allison Taylor Walker, PhD; Benjamin H. Rome, MBA; Siyao Lisa Li; Thomas W. S. Aichele, MBA; Rob Stein; Ezra T. Ernst; Robert C. Morfino, MBA; Martin S. Cetron, MD; Cindy R. Friedman, MD. MMWR Morb Mortal Wkly Rep 2023;72:206–209.

During December 6, 2021–June 11, 2022, SARS-CoV-2 testing before departure or proof of recent COVID-19 recovery were required for passengers boarding U.S.-bound flights. CDC’s Traveler-based Genomic Surveillance Program collects postarrival nasal swabs for SARS-CoV-2 testing from volunteering international air travelers. Among 3,049 pooled (28,056 individual) samples collected during March 20–September 3, 2022, the predeparture testing requirement was associated with 52% lower postarrival SARS-CoV-2 positivity. We found that predeparture testing can reduce SARS-CoV-2 transmission risk during or after travel by reducing the number of infectious travelers. These results can help guide decisions for future outbreaks.

Building a Biological Radar for Monitoring Harmful Biology

Casandra Philipson

Chemical Engineering Progress, May 2023

The scientific and policy toolkit must evolve in lockstep with the biological risk landscape. Specifically, the biosurveillance ecosystem needs to layer in solutions that: focus on monitoring trends over time to inform intermediate-term planning and readily identify anomalies, provide early indicators that can help authorities mount timely responses to outbreaks or disruptive events, survey a broad landscape of ongoing and emerging threats, are more cost-effective and less time-consuming than mass testing, can scale rapidly and efficiently during periods of elevated risk or acute transmission. Two sets of tools, in particular, will be critical to building biological radar: genomic surveillance and passive environ-mental monitoring.

A new paradigm for threat-agnostic biodetection: biological intelligence (BIOINT)

Tom Knight and Swati Sureka (Under review)

As we face increasing risks of biological threats—whether from spillover, misuse, or other sources—current syndromic surveillance approaches are inadequate to provide early warning. We have an unprecedented opportunity and urgent need to understand our biological environment in a comprehensive way, through the new discipline of biological intelligence (BIOINT). BIOINT is persistent and pervasive within and beyond crises, pushes surveillance closer to sites of emergence rather than illness, takes a layered approach, integrating sequencing of environmental nucleic acids with other sources of data. Technological progress is reducing barriers to implementation and resourcing, but collective action is needed to create the infrastructure for not only collecting and analyzing, but also integrating, sharing, and operationalizing BIOINT data.