Continuous Circulation of Hepatitis E and A Viruses During COVID-19 Pandemic Lockdowns in Munich, Germany—Experience from Three Years of Wastewater Surveillance

The COVID-19 pandemic has increased interest in wastewater-based epidemiology (WBE) as a reliable and cost-effective framework for monitoring the spread of microbes. However, WBE frameworks have rarely been applied to the study of fecal–oral transmissible diseases, except for poliomyelitis. Here, we investigated the presence of hepatitis A virus (HAV) and hepatitis E virus (HEV) in wastewater in Munich. We collected wastewater samples between July 2020 and November 2023. A total of 186 samples were processed using centrifugation and analyzed for HAV- and HEV-RNA using RT-qPCR. As a reference, we used notification data from clinically or laboratory-diagnosed hepatitis A and E cases. Lockdown stringency levels were derived from official documentation. Our results show that 87.6% of wastewater samples were positive for HEV at concentrations of 9.0 × 101 to 2.5 × 105 copies/L, while HAV was only detectable in 7.5% of the samples at viral loads of 4.6 × 101 to 2.4 × 103 copies/L. We also detected differences in HEV concentrations but not in case numbers when comparing lockdown and no-lockdown periods. This study covers all but the first lockdowns in Bavaria. We present a unique real-world dataset evaluating the impact of lockdown interventions on hepatitis A and E case numbers, as well as on the concentrations of HAV and HEV in wastewater. Person-to-person spread and eating out appear to have contributed to the transmission of HEV. In addition, the consistently high HEV concentrations in sewage support the findings of serological studies, indicating a substantial burden of undetected subclinical infections.