{
  "abstract": "Wastewater surveillance (WWS) of SARS-CoV-2 RNA levels offers a way to monitor virus circulation independently of clinical testing. With COVID-19 now endemic, clarifying the role of WWS within routine surveillance is essential. The aim was to evaluate the potential of WWS as an early warning indicator for COVID-19 in Sweden, based on its correlation with reported case data. The study includes data from July 2023 to December 2024, from 19 wastewater treatment plants (WWTPs), covering 43% of Sweden’s population, and surveillance data of reported COVID-19 cases. Analyses were performed by WWTP, separately for Stockholm (4 WWTPs) and at a national level (19 WWTPs). We compared wastewater SARS-CoV-2 levels to reported COVID-19 cases using cross-correlation and prediction metrics following trend classification. Correlations and classification metrics were highest without time shifts. SARS-CoV-2 levels in wastewater were strongly correlated with reported COVID-19 cases, with median cross-correlation values of 0.80 across all WWTPs and 0.87 at Stockholm and national levels. Positive predictive values of wastewater data to reported cases ranged from 63–74%, and negative predictive values from 85–95%. Sensitivity and specificity in Stockholm reached 78% and 87%; at national level, 72% and 84%, respectively. Under the evaluated weekly sampling and reporting system, WWS did not demonstrate a consistent early-warning advantage over reported cases but may support monitoring of trends when clinical testing is reduced.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Communicable Disease Control and Health Protection, Public Health Agency of Sweden, Solna, Sweden",
    "ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden",
    "Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden",
    "Department of Aquatic Sciences and Assessment, Science for Life Laboratory, Swedish University of Agricultural Sciences, Uppsala, Sweden"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Anna Ohlson"
    },
    {
      "affs": [
        1
      ],
      "name": "Moa Rehn"
    },
    {
      "affs": [
        2
      ],
      "name": "Sharon Kühlmann Berenzon"
    },
    {
      "affs": [
        3
      ],
      "name": "Erik Sturegård"
    },
    {
      "name": "Rakel Brodin"
    },
    {
      "name": "Anna J. Székely"
    },
    {
      "name": "Sofia Persson"
    },
    {
      "name": "Ilias Galanis"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/96a9fjyxjx2kg.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0358326",
  "fulltext_url": null,
  "id": "96a9fjyxjx2kg",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0358326",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2725|SARS-CoV-2 detection and testing"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Coronaviruses/SARS coronavirus/SARS CoV 2"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Virology/Viral transmission and infection/Viral release"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/RNA viruses/Coronaviruses/SARS coronavirus/SARS CoV 2"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Coronaviruses/SARS coronavirus/SARS CoV 2"
    ],
    [
      "plos",
      "/Medicine and health sciences/Diagnostic medicine/Virus testing"
    ],
    [
      "plos",
      "/Medicine and health sciences/Epidemiology/Disease surveillance/Infectious disease surveillance"
    ],
    [
      "plos",
      "/Medicine and health sciences/Epidemiology/Pandemics"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Infectious diseases/Infectious disease control/Infectious disease surveillance"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Infectious diseases/Viral diseases/COVID 19"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Coronaviruses/SARS coronavirus/SARS CoV 2"
    ],
    [
      "plos",
      "/Medicine and health sciences/Public and occupational health"
    ],
    [
      "plos",
      "/People and places/Geographical locations/Europe/European Union/Sweden"
    ]
  ],
  "openalex": "W7213931898",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0358326&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-21",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/96a9fjyxjx2kg.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:43Z",
      "native_id": "10.1371/journal.pone.0358326",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0358326"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "plos:microbiology",
      "subfield": "microbiology"
    },
    {
      "field": "medicine",
      "origin": "plos:epidemiology",
      "subfield": "epidemiology-public-health"
    },
    {
      "field": "medicine",
      "origin": "plos:infectious diseases",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Evaluation of wastewater SARS-CoV-2 surveillance for monitoring COVID-19 trends and early warning in Sweden, 2023–2024",
  "title_text": "Evaluation of wastewater SARS-CoV-2 surveillance for monitoring COVID-19 trends and early warning in Sweden, 2023–2024",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:43Z",
  "url": "https://research.draconitic.com/paper/96a9fjyxjx2kg",
  "venue": "PLOS One",
  "versions": []
}