{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T19:11:49Z","timestamp":1771441909913,"version":"3.50.1"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NU38FT000006-01-00"],"award-info":[{"award-number":["NU38FT000006-01-00"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Hepatitis A virus (HAV) remains a significant public health concern in the United States. Because infected individuals shed virus through stool, HAV can be detected in wastewater. Shedding occurs prior to the onset of symptoms that lead to clinical diagnosis, highlighting the potential of wastewater as an early case detection tool. This analysis aims to quantify key diagnostic metrics of wastewater surveillance for detecting HAV cases, which have not been previously defined. Utilizing wastewater data from the Point Loma Wastewater Treatment Facility in San Diego County, which serves around 2.2 million people, we assessed the sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of wastewater HAV signals (positive\/negative) in identifying shedding cases over a 308-day period. The number of people shedding virus on a given day was estimated through confirmed cases and presumed shedding intervals (2 weeks before and 1 week after symptom onset) and compared to wastewater signals. The sensitivity in detecting at least one shedding case on a given day using observed wastewater signals was 48.1%. Reclassifying the wastewater signal using simple data aggregations yielded sensitivities from 67.3% to 84.6%. Sensitivity increased as more individuals were shedding virus. The highest PPV (52.2%) and NPV (74.2%) were observed when a 5-sample trimmed centered average was used to reclassify the wastewater signal, indicating the utility of this preprocessing method. Conditional on clinical case detection and shedding assumptions, our study demonstrates that wastewater is a promising tool, providing signals that can inform public health surveillance.<\/jats:p>","DOI":"10.1371\/journal.pone.0342229","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T18:25:02Z","timestamp":1771439102000},"page":"e0342229","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the sensitivity and predictive value of wastewater in detection of Hepatitis A cases in San Diego County"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5758-0718","authenticated-orcid":true,"given":"Aishwarya","family":"Ramesh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0358-2435","authenticated-orcid":true,"given":"Ravi","family":"Goyal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Stous","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah R.","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seema","family":"Shah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eliah","family":"Aronoff-Spencer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark E.","family":"Beatty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha K.","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,18]]},"reference":[{"key":"pone.0342229.ref001","article-title":"Chapter 9: Hepatitis A.","author":"MA Foster","year":"2021","edition":"14"},{"issue":"1","key":"pone.0342229.ref002","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1038\/s41597-023-02297-7","article-title":"Human viral nucleic acids concentrations in wastewater solids from Central and Coastal California USA","volume":"10","author":"AB Boehm","year":"2023","journal-title":"Sci Data"},{"key":"pone.0342229.ref003","year":"2024"},{"key":"pone.0342229.ref004","doi-asserted-by":"crossref","first-page":"121463","DOI":"10.1016\/j.watres.2024.121463","article-title":"Urban wastewater-based epidemiology for multi-viral pathogen surveillance in the Valencian region, Spain","volume":"255","author":"I Gir\u00f3n-Guzm\u00e1n","year":"2024","journal-title":"Water Res"},{"key":"pone.0342229.ref005","doi-asserted-by":"crossref","first-page":"175473","DOI":"10.1016\/j.scitotenv.2024.175473","article-title":"Prevalence of hepatitis A and E viruses in wastewater in Asian countries","volume":"951","author":"S Raya","year":"2024","journal-title":"Sci Total Environ"},{"key":"pone.0342229.ref006","doi-asserted-by":"crossref","first-page":"176923","DOI":"10.1016\/j.scitotenv.2024.176923","article-title":"Wastewater-based surveillance for Hepatitis A virus, Enterovirus, Poliovirus, and SARS-CoV-2 in S\u00e3o Tom\u00e9 and Pr\u00edncipe: A pilot study","volume":"955","author":"K Toancha","year":"2024","journal-title":"Sci Total Environ"},{"issue":"21","key":"pone.0342229.ref007","doi-asserted-by":"crossref","first-page":"6771","DOI":"10.1128\/AEM.01981-14","article-title":"Detection of pathogenic viruses in sewage provided early warnings of hepatitis A virus and norovirus outbreaks","volume":"80","author":"M Hellm\u00e9r","year":"2014","journal-title":"Appl Environ Microbiol"},{"issue":"7","key":"pone.0342229.ref008","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2807\/1560-7917.ES.2018.23.7.17-00237","article-title":"Monitoring human enteric viruses in wastewater and relevance to infections encountered in the clinical setting: a one-year experiment in central France, 2014 to 2015","volume":"23","author":"M Bisseux","year":"2018","journal-title":"Euro Surveill"},{"key":"pone.0342229.ref009","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1186\/1471-2334-14-419","article-title":"Surveillance of hepatitis A virus in urban sewages and comparison with cases notified in the course of an outbreak, Italy 2013","volume":"14","author":"G La Rosa","year":"2014","journal-title":"BMC Infect Dis"},{"key":"pone.0342229.ref010","doi-asserted-by":"crossref","first-page":"120102","DOI":"10.1016\/j.watres.2023.120102","article-title":"Hepatitis A virus monitoring in wastewater: A complementary tool to clinical surveillance","volume":"241","author":"A Fantilli","year":"2023","journal-title":"Water Res"},{"issue":"3","key":"pone.0342229.ref011","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1111\/jam.15027","article-title":"Assessment of enteric viruses during a hepatitis outbreak in Detroit MI using wastewater surveillance and metagenomic analysis","volume":"131","author":"C McCall","year":"2021","journal-title":"J Appl Microbiol"},{"key":"pone.0342229.ref012","doi-asserted-by":"crossref","first-page":"178862","DOI":"10.1016\/j.scitotenv.2025.178862","article-title":"Seasonality of enteric viruses and correlation of hepatitis a virus in wastewater with clinical cases","volume":"967","author":"C Chettleburgh","year":"2025","journal-title":"Sci Total Environ"},{"issue":"10","key":"pone.0342229.ref013","first-page":"4123","article-title":"Detection of Hepatovirus A (HAV) in wastewater indicates widespread national distribution and association with socioeconomic indicators of vulnerability","volume":"58","author":"A Zulli","year":"2024","journal-title":"Environ Sci Technol"},{"issue":"5","key":"pone.0342229.ref014","doi-asserted-by":"crossref","first-page":"66","DOI":"10.15585\/mmwr.mm7405a3","article-title":"Notes from the Field: Genomic and wastewater surveillance data to guide a hepatitis A Outbreak Response - Los Angeles County, March 2024-June 2024","volume":"74","author":"JB Braunfeld","year":"2025","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"pone.0342229.ref015","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1186\/s12879-024-09938-1","article-title":"Use of passive samplers as sewage surveillance tool to monitor a hepatitis A outbreak at a school in Amsterdam, the Netherlands, Oct 2022 - March 2023","volume":"24","author":"M de Jong","year":"2024","journal-title":"BMC Infect Dis"},{"key":"pone.0342229.ref016"},{"key":"pone.0342229.ref017"},{"key":"pone.0342229.ref018"},{"issue":"2","key":"pone.0342229.ref019","doi-asserted-by":"crossref","first-page":"37","DOI":"10.15585\/mmwr.mm7302a3","article-title":"Detecting Mpox Cases through wastewater surveillance - United States, August 2022-May 2023","volume":"73","author":"C Adams","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"11","key":"pone.0342229.ref020","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1002\/jmv.20711","article-title":"High and persistent excretion of hepatitis A virus in immunocompetent patients","volume":"78","author":"GMS Tjon","year":"2006","journal-title":"J Med Virol"},{"issue":"5","key":"pone.0342229.ref021","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1093\/infdis\/142.5.654","article-title":"Patterns of shedding of hepatitis A virus antigen in feces and of antibody responses in patients with naturally acquired type A hepatitis","volume":"142","author":"JS Mao","year":"1980","journal-title":"J Infect Dis"},{"issue":"1","key":"pone.0342229.ref022","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12879-018-3070-4","article-title":"Population sensitivity of acute flaccid paralysis and environmental surveillance for serotype 1 poliovirus in Pakistan: an observational study","volume":"18","author":"KM O\u2019Reilly","year":"2018","journal-title":"BMC Infect Dis"},{"key":"pone.0342229.ref023","doi-asserted-by":"crossref","first-page":"100310","DOI":"10.1016\/j.envadv.2022.100310","article-title":"Testing specificity and sensitivity of wastewater-based epidemiology for detecting SARS-CoV-2 in four communities on Vancouver Island, Canada","volume":"9","author":"NZ Masri","year":"2022","journal-title":"Environ Adv"},{"key":"pone.0342229.ref024","doi-asserted-by":"crossref","first-page":"118032","DOI":"10.1016\/j.watres.2021.118032","article-title":"Sensitivity of wastewater-based epidemiology for detection of SARS-CoV-2 RNA in a low prevalence setting","volume":"211","author":"J Hewitt","year":"2022","journal-title":"Water Research"},{"issue":"11","key":"pone.0342229.ref025","doi-asserted-by":"crossref","first-page":"6451","DOI":"10.1021\/acs.est.0c02271","article-title":"Potential sensitivity of wastewater monitoring for SARS-CoV-2: Comparison with norovirus cases","volume":"54","author":"A Hata","year":"2020","journal-title":"Environ Sci Technol"},{"issue":"1","key":"pone.0342229.ref026","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1186\/s12889-022-13499-w","article-title":"Unmet health needs and barriers to health care among people experiencing homelessness in San Francisco\u2019s Mission District: A qualitative study","volume":"22","author":"AL Thorndike","year":"2022","journal-title":"BMC Public Health"},{"key":"pone.0342229.ref027","doi-asserted-by":"crossref","first-page":"618352","DOI":"10.3389\/fmicb.2021.618352","article-title":"Persistence of Hepatitis A virus rna in water, on non-porous surfaces, and on blueberries","volume":"12","author":"M Trudel-Ferland","year":"2021","journal-title":"Front Microbiol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0342229","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T18:25:06Z","timestamp":1771439106000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0342229"}},"subtitle":[],"editor":[{"given":"Dhammika Leshan","family":"Wannigama","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,18]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0342229","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,18]]}}}