Wastewater-based surveillance for influenza and respiratory syncytial virus: Insights from a 21-month study in...

Upper respiratory infections caused by viruses such as respiratory syncytial virus (RSV) and influenza are major health concerns globally. Traditional surveillance methods of these viruses rely on clinical data, which can miss mild or asymptomatic cases, leading to gaps in understanding of their epidemiology. Wastewater-based surveillance (WBS) offers an alternative monitoring approach, providing real-time, population-representative data infection levels. This study aimed to evaluate the value of WBS for monitoring influenza A and B and RSV in Oklahoma from August 2022 to May 2024. Wastewater samples were collected weekly from 18 treatment plants statewide, and viral RNA was quantified using RT-qPCR. We compared wastewater data with reported influenza hospitalizations and RSV test positivity. We found significant seasonality in clinical outcomes as well as wastewater concentrations for influenza A and RSV. Our results also showed comparatively high wastewater concentrations during times when influenza hospitalizations and RSV test positivity were at their seasonal highs. Our study demonstrates the potential for WBS to offer timely insights into respiratory virus trends, particularly for underserved communities. This method complements traditional surveillance, offering a broader understanding of viral transmission and supporting public health interventions.