The Hyderabad Cluster’s APSI Story

To meet the goals of the Rockefeller Foundation-funded APSI project to set up robust systems of disease surveillance using environmental samples, the Centre for Cellular and Molecular Biology (CCMB) in Hyderabad has formed partnerships with academic and medical institutions which form the Hyderabad cluster. With help from the Foundation’s funding, CCMB established partnerships with three institutions during 2022: The All India Institute for Medical Sciences (AIIMS), Bibinagar, Pasteur Institute, Shillong and LV Prasad Eye Institute (LVPEI), Hyderabad.

CCMB and its partners conduct wastewater and clinical surveillance for presence of viral and/or bacterial pathogens (besides SARS-CoV-2) responsible for causing diseases in humans, including assessment of antimicrobial resistance genes (ARGs) contributing to antimicrobial resistance (AMR).

Pasteur Institute in Shillong focuses on the directly transmissible diseases such as diarrheal diseases caused by Escherichia coli as well as pathogens causing acute febrile illnesses in pediatric patients. These are considered as priority diseases owing to their respective load in the population in Shillong as well as being listed as high priority agents in the ICMR/WHO List of Priority Pathogens contributing to AMR. The surveillance network at the Pasteur Institute, Shillong primarily targets wastewater / sewage systems (from Shillong Agglomeration and selected Health Care Facility) and trains staff at the Institute to not only collect adequate number of representative wastewater/patient samples, but also to efficiently train and develop such surveillance capacity in future. The systems and networks developed at CCMB are, hence, being enhanced and strengthened to incorporate large-scale pathogen profiling from environmental samples from Hyderabad to other parts of India.

CCMB and AIIMS team members at a wastewater (open drain) site used for sample collection at a rural area near AIIMS, Bibinagar

Our other partner institution, LVPEI, provides CCMB with ocular cultured samples from patients with eye infections and who were advised antibiotic therapy post-treatment. CCMB utilizes next generation sequencing (NGS) methods to evaluate these samples for presence of ARGs. AIIMS provides CCMB with wastewater samples (open drains) from eight rural areas around Bibinagar, Hyderabad. Using NGS and bioinformatics tools, CCMB’s team evaluates these samples for presence of pathogens and ARGs.

CCMB also continues to use 18 wastewater sampling sites in Hyderabad to detect SARS-CoV-2 as well as the presence of ARGs which may contribute to AMR. In order to expand the environmental surveillance in multiple regions, additional sites have been added from other regions of India. These include several sites in various cities in India including Prayagraj, Delhi, Kolkata, Chennai, Mumbai and Nagpur. Collectively with our partners, CCMB’s goals are to evaluate presence of pathogens contributing to AMR by conducting environmental sampling.

Wastewater collection from a Sewage Treatment Plant in Hyderabad

All human research protocols are approved by institutional ethical clearance and biosafety committees and personnel follow strict biosafety measures while collecting and processing clinical and environmental samples. Through intense outreach efforts among the medical communities and stakeholders/policy makers in the healthcare sector, we hope to hand over the surveillance tools developed at CCMB and its partners to public health authorities at local, state and national levels for implementing a sustainable surveillance program which can detect pathogens in a non-invasive manner and alert public health authorities to predict disease outbreaks.

An in-person meeting held at CCMB on June 13th, 2023 featured scientific presentations and discussions on wastewater surveillance from CCMB and its partners from AIIMS, Bibinagar, LV Prasad Eye Institute, Hyderabad and Pasteur Institute, Shillong