Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
Volume 30, Number 9—September 2024
Dispatch
Participatory, Virologic, and Wastewater Surveillance Data to Assess Underestimation of COVID-19 Incidence, Germany, 2020–2024
Figure
![Incidence and underestimation factors in a study of participatory, virologic, and wastewater surveillance data to assess underestimation of COVID-19 incidence, Germany, 2020–2024. A) Smoothed and unsmoothed surveillance data on COVID-19 incidence (cases/100,000 adult population) compared with wastewater viral load. SARS-CoV-2 variant phases in Germany are labeled. B) Two different UEFs plus common piecewise trendline of smoothed UEF and timeframes for phases calendar week 40 of 2020 through calendar week 4 of 2024. Vertical lines mark the breakpoints between COVID-19 phases with different degrees of underestimation. GNS-I, incidence from German notification system; GW-SR-I, GrippeWeb self-reported incidence; GW-VPR-I, GrippeWeb and virologic positivity rate incidence; SC2-VL-WW, aggregated SARS-CoV-2 viral load in wastewater; UEF, underestimation factor.](/eid/images/24-0640-F1.jpg)
Figure. Incidence and underestimation factors in a study of participatory, virologic, and wastewater surveillance data to assess underestimation of COVID-19 incidence, Germany, 2020–2024. A) Smoothed and unsmoothed surveillance data on COVID-19 incidence (cases/100,000 adult population) compared with wastewater viral load. SARS-CoV-2 variant phases in Germany are labeled. B) Two different UEFs plus common piecewise trendline of smoothed UEF and timeframes for phases calendar week 40 of 2020 through calendar week 4 of 2024. Vertical lines mark the breakpoints between COVID-19 phases with different degrees of underestimation. GNS-I, incidence from German notification system; GW-SR-I, GrippeWeb self-reported incidence; GW-VPR-I, GrippeWeb and virologic positivity rate incidence; SC2-VL-WW, aggregated SARS-CoV-2 viral load in wastewater; UEF, underestimation factor.
1These first authors contributed equally to this article.