A new study from the University of Minnesota found that SARS-CoV-2 levels in wastewater accurately predicted the subsequent COVID-19 case count the following week in the community, adding further evidence to the usefulness of wastewater detection. 

The observational study was published today in the Journal of Infectious Diseases. The authors said the study was conducted to assess the usefulness of wastewater detections for COVID-19 now that widespread community immunity has been obtained through infection and vaccination. 

Determining epidemiologic trends of virus spread and the burden of disease at the community level has become challenging.

“Determining epidemiologic trends of virus spread and the burden of disease at the community level has become challenging. Tracking the spread of infection throughout the community as well as the emergence of new variants remains important,” the authors wrote. 

The study took place from January 2022 through August 2024 and analyzed the correlation between symptomatic COVID-19 in healthcare employees and SARS-CoV-2 wastewater community levels in 215 wastewater samples from the Twin Cities Wastewater Treatment Plant.

Three distinct surges seen 

During the study period, there were 6,879 positive SARS-CoV-2 test results reported to Fairview Employee Health from people who lived in the wastewater catchment area. All non–remote work Fairview Health employees must present evidence of a positive COVID-19 test result prior to being excused from work.

“In the 32 months of our study, we observed 3 distinct surges in case counts and correlative levels of virus in wastewater,” the authors wrote. The surges, which took place in January 2022, July 2023, and June 2024 were characterized by a rapid increase in case counts and quantity of virus in wastewater.

In two models used by the authors, the surges in wastewater detection accurately predicted case counts for the following week. 

“These data unequivocally demonstrate that levels of SARS-CoV-2 in wastewater predict the frequency of symptomatic COVID-19 in the community approximately a week in advance of the clinical cases,” they concluded. 

A small, non-randomized pilot clinical trial found that fecal microbiota transplantation (FMT) was well-tolerated in long-term acute care hospital (LTACH) patients colonized with multidrug-resistant organism (MDROs), researchers reported today in JAMA Network Open.

For the trial, which was conducted from April to December 2023 at an LTACH in the southeastern United States, a team led by researchers from Emory University enrolled 42 patients with MDRO colonization, with 10 selected to receive FMT via gastrostomy or enema and 32 in the control group. LTACH populations have a high prevalence of MDRO colonization, which can put them at increased risk of MDRO infection, and investigators wanted to see if FMT might be a safe way to help reduce intestinal MDRO colonization. 

The primary outcome was the frequency and severity of adverse events. The secondary outcome was the proportion of participants with positive perirectal or stool culture results at week 2 and 4 after FMT.

No serious adverse events attributed to FMT

No serious adverse events were attributed to FMT, and post-FMT solicited adverse were mild. All perirectal cultures from FMT recipients grew at least one MDRO at days 14 and 28. Although post hoc analyses found that fewer FMT recipients had positive blood culture results and pathogen intestinal dominance compared with controls in the 6 months after prevalence survey, and that FMT recipients had numerically fewer days of antibiotic therapy per 1000 patient-days than controls, these differences were not statistically significant.  

The study authors say that while the effect on MDRO decolonization observed in the trial was smaller than found in previous studies, the findings suggest FMT warrants further investigation for infection prevention.

"Although a small cohort was studied, these findings suggest that microbiota therapies, particularly with improved formulations that are easier to administer and acceptable to patients, could have potential for preventive treatment for patients at high risk of infection or transmission," they wrote. "This approach could be especially important for LTACHs and other health care facilities that care for patients with a high prevalence of intestinal MDRO colonization for which there are no currently available FDA-approved therapies."