Introduction of wastewater surveillance of SARS-CoV-2 in Ukraine

Abstract Since the Russian invasion, Ukraine has faced humanitarian crises and challenges in diseases surveillance. The primary healthcare (PHC) system struggled with growing numbers of internally displaced and wounded people. In October 2022, the PATH-led, USAID-funded Support TB Control Efforts in Ukraine (STBCEU) project, supported implementation of wastewater surveillance (WWS) for SARS-CoV-2 in four oblasts on request of the Ministry of Health (MoH), expanding to 18 oblasts by October 2023. Samples were collected from 64 sites twice per week and tested for SARS-CoV-2 and influenza A/B using BioExtract® Premium Mag test kits in regional laboratories. From October 2022 to April 2024, 4,784 samples were collected at municipal aqueducts, with SARS-CoV-2 delta and omicron variants detected across all regions. WWS sample results were compared with routine surveillance to assess trends in concentrations and reported cases among population. Gradual decrease in SARS-CoV-2 concentration to zero by May 29, 2023, coincided with a decrease in morbidity. In the last week of August 2023, the concentration of the SARS-CoV-2 in wastewater began its gradual increase with the beginning of new cases registration among the population within 2 weeks, by mid-September. From October 2023, SARS-CoV-2 dominated in 96.6% of positive WWS testing results; in other specimens, influenza and respiratory viruses have been identified. The implementation of WWS in Ukraine highlighted its effectiveness as a public health tool in settings where traditional surveillance methods are disrupted, providing timely data on the viral pathogens for outbreaks prediction and responses, underscoring its role in preventive health measures. The MOH of Ukraine recommended extending the method nationwide for routine surveillance of SARS-CoV-2 and other pathogens, enhancing Ukraine’s capacity to manage public health threats and strengthen the resilience of its health system against future crises. Key messages • WWS in Ukraine underscores its effectiveness as a public health tool, providing timely data on viral pathogens for outbreak prediction and response in disrupted settings. • Notable decline in SARS-CoV-2 concentration in wastewater correlates with reduced morbidity, highlighting WWS’s predictive value.