Wastewater Respiratory Virus Surveillance in Remote Community, Alaska, USA, 2022-2024

Wastewater surveillance (WS) is underused in rural communities. We evaluated WS performance in the remote, subarctic, mostly Indigenous, community of Bethel, Alaska, USA, during October 2022-May 2024. Wastewater was collected >3 times weekly and underwent on-site PCR testing for SARS-CoV-2, respiratory syncytial virus (RSV), and influenza A and B viruses. We compared WS virus detection with local clinical data by using results from 318 wastewater samples and 7,392 clinical tests. We detected SARS-CoV-2 in 265 (83.3%) wastewater samples, influenza A virus in 128 (40.3%), RSV in 78 (24.5%), and influenza B virus in 29 (9.1%). Wastewater signals correlated with clinical results for influenza B virus (Spearman ρ = 0.85), influenza A virus (ρ = 0.62), RSV (ρ = 0.60), and SARS-CoV-2 (ρ = 0.59), providing corroborating data that informed the timing of seasonal respiratory virus immunization campaigns. Our findings show that WS is feasible and useful for disease surveillance in rural Alaska.