Wastewater-Based Surveillance Accurately Monitoring Influenza A, B, and RSV

A man standing in front of a large display of computer screens for a wastewater treatment plant.

(Adobe Stock 584945266 by CleverStock)

Surveillance of wastewater of the 3 most common infectious diseases beyond SARS-CoV-2--influenza A, influenza B and RSV--correlated closely with clinical cases reported in Calgary, Canada, as noted in a recent study.

The research presented at IDWeek 2023, held in Boston, Massachusetts, from October 11 to 15, 2023, “Expanded use of wastewater-based surveillance unveils emerging flu [influenza] and RSV [respiratory syncytial virus] trends,” demonstrates the effectiveness of wastewater-based surveillance in accurately tracking influenza A, influenza B, and RSV at the population level. This method serves as an objective tool for informing public responses to common seasonal illnesses.

According to its website, “IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP).”

The study revealed a strong correlation between viral signals detected in Calgary, Canada's wastewater and the weekly confirmed clinical cases of all 3 viruses. Specifically, influenza A peaked in the wastewater samples between November and December 2022, influenza B between February and April 2023, and RSV between November 2022 and February 2023.

Data for this study were collected through weekly sampling of 24-hour composite wastewater samples from 3 treatment plants in Calgary from March 2022 to April 2023. These wastewater findings were then compared to clinical data provided by Alberta Health Services, including total cases and test positivity rates across Calgary and Alberta, Canada.

Kristine Du, BSc, a lab technician at the Cumming School of Medicine at the University of Calgary and the presenting author, emphasized the significance of wastewater surveillance. She highlighted that even a single flush can yield valuable information. "Wastewater surveillance equips public health experts, clinicians, policymakers and the public with community-based, objective data to inform health and safety decisions against the flu and RSV,"she is quoted on the poster.

Wastewater surveillance equips various stakeholders, including public health experts, clinicians, policymakers, and the public, with community-based, unbiased data that can guide health and safety decisions regarding influenza and RSV. Knowing which viruses are prevalent in the community helps individuals and communities prepare accordingly.

The researchers believe that these results introduce a novel surveillance approach that operates independently of clinical testing and complements it. This approach enables the detection of common seasonal respiratory viruses, building upon the prominence of wastewater surveillance during the COVID-19 pandemic. Understanding viral trends at the community level can pinpoint hotspots, inform local public health decisions, and prepare clinicians and hospitals for potential outbreaks.

Looking ahead, the researchers suggest that expanding the scope of respiratory viruses included in wastewater surveillance will provide a comprehensive assessment of viral respiratory disease activity.

In addition to Du, study co-authors include: Nicole Acosta, PhD; Barbara Waddell, BSc; Maria Bautista, PhD, MSc; Janine McCalder, BSc; Aito Ueno, PhD; Sudha Bhavanam, PhD; September Stefani; Carolyn Visser, BSc; Chloe Papparis; Puja Pradhan; Lance Non; Paul Montesclaros; Imesha Perera, MSc; Jennifer Van Doorn; Kashtin Low, BSc; Kevin Xiang; Leslie Chan; Laura Vivas; Judy Qiu, PhD; Tiejun Gao, PhD, MSc; Rhonda Clark, PhD; Danielle Southern, MSc; Tyler Williamson, PhD; John Conly, MD; Xiao-Li Pang, PhD; Bonita Lee, MD; Steve Hrudey, PhD; Kevin Frankowski, MASc; Casey RJ Hubert, PhD; and Michael Parkins, MD, MSc.