{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:07:07Z","timestamp":1790399227457,"version":"4.1.0"},"reference-count":52,"publisher":"IWA Publishing","issue":"5","license":[{"start":{"date-parts":[[2023,4,10]],"date-time":"2023-04-10T00:00:00Z","timestamp":1681084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000276","name":"Department of Health and Social Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["iwaponline.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:p>Wastewater-based epidemiology (WBE) is a valuable tool for monitoring the circulation of COVID-19. However, while variations in population size are recognised as major sources of uncertainty, wastewater SARS-CoV-2 measurements are not routinely population-normalised. This paper aims to determine whether dynamic population normalisation significantly alters SARS-CoV-2 dynamics observed through wastewater monitoring, and whether it is beneficial or necessary to provide an understanding of COVID-19 epidemiology. Data from 394 sites in England are used, and normalisation is implemented based on ammoniacal nitrogen and orthophosphate concentrations. Raw and normalised wastewater SARS-CoV-2 metrics are evaluated at the site and spatially aggregated levels are compared against indicators of prevalence based on the Coronavirus Infection Survey and Test and Trace polymerase chain reaction test results. Normalisation is shown, on average, to have a limited impact on overall temporal trends. However, significant variability in the degree to which it affects local-level trends is observed. This is not evident from previous WBE studies focused on single sites and, critically, demonstrates that while the impact of normalisation on SARS-CoV-2 trends is small on average, this may not always be the case. When averaged across many sites, normalisation strengthens the correlation between wastewater SARS-CoV-2 data and prevalence indicators; however, confidence in the improvement is low.<\/jats:p>","DOI":"10.2166\/wh.2023.318","type":"journal-article","created":{"date-parts":[[2023,4,10]],"date-time":"2023-04-10T16:14:32Z","timestamp":1681143272000},"page":"625-642","update-policy":"https:\/\/doi.org\/10.2166\/iwapcrossmarkpolicypage","source":"Crossref","is-referenced-by-count":23,"title":["Dynamic population normalisation in wastewater-based epidemiology for improved understanding of the SARS-CoV-2 prevalence: a multi-site study"],"prefix":"10.2166","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9329-5367","authenticated-orcid":false,"given":"Chris","family":"Sweetapple","sequence":"first","affiliation":[{"name":"a UK Health Security Agency, Environmental Monitoring for Health Protection, Nobel House, London SW1P 3JR, United Kingdom"},{"name":"b Centre for Water Systems, Faculty of Environment, Science and Economy, University of Exeter, Exeter EX4 4QF, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Wade","sequence":"additional","affiliation":[{"name":"a UK Health Security Agency, Environmental Monitoring for Health Protection, Nobel House, London SW1P 3JR, United Kingdom"},{"name":"c School of Engineering, Newcastle University, Newcastle-upon-Tyne NE1 7RU, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Melville-Shreeve","sequence":"additional","affiliation":[{"name":"b Centre for Water Systems, Faculty of Environment, Science and Economy, University of Exeter, Exeter EX4 4QF, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert S.","family":"Chen","sequence":"additional","affiliation":[{"name":"b Centre for Water Systems, Faculty of Environment, Science and Economy, University of Exeter, Exeter EX4 4QF, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Lilley","sequence":"additional","affiliation":[{"name":"a UK Health Security Agency, Environmental Monitoring for Health Protection, Nobel House, London SW1P 3JR, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Irving","sequence":"additional","affiliation":[{"name":"a UK Health Security Agency, Environmental Monitoring for Health Protection, Nobel House, London SW1P 3JR, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine M.S.","family":"Grimsley","sequence":"additional","affiliation":[{"name":"a UK Health Security Agency, Environmental Monitoring for Health Protection, Nobel House, London SW1P 3JR, United Kingdom"},{"name":"d The London Data Company, London EC2N 2AT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua T.","family":"Bunce","sequence":"additional","affiliation":[{"name":"a UK Health Security Agency, Environmental Monitoring for Health Protection, Nobel House, London SW1P 3JR, United Kingdom"},{"name":"c School of Engineering, Newcastle University, Newcastle-upon-Tyne NE1 7RU, United Kingdom"},{"name":"e Department for Environment, Food and Rural Affairs, Seacole Building, London SW1P 4DF, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"945","published-online":{"date-parts":[[2023,4,10]]},"reference":[{"key":"2023072410121425500_JWH-D-22-00318C1","doi-asserted-by":"crossref","first-page":"117369","DOI":"10.1016\/j.watres.2021.117369","article-title":"A multicenter study investigating SARS-CoV-2 in tertiary-care hospital wastewater. viral burden correlates with increasing hospitalized cases as well as hospital-associated transmissions and outbreaks","volume":"201","year":"2021","journal-title":"Water 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