SARS-CoV-2 wastewater concentration and linked longitudinal seroprevalence: a spatial analysis of strain mutation, post-COVID-19 vaccination effect, and hospitalization burden forecasting.

Our results show the potential of sustained environmental surveillance post-vaccine in urban areas and on removing bias in population-level estimates of prevalence of SARS-CoV-2 due to over-reliance on reported clinical testing data. The methodology presented here provides further proof wastewater monitoring can be successfully used as a tool for estimating both the community impact of changing disease patterns and various interventions over time. These findings have implications beyond current SARS-CoV-2 pandemic since our proposed approach is quite general and can be applied to other vaccine preventable diseases affecting human health in the absence of clinical testing data.