Observations
of Respiratory Syncytial Virus (RSV)
Nucleic Acids in Wastewater Solids Across the United States in the
2022–2023 Season: Relationships with RSV Infection Positivity
and Hospitalization Rates
posted on 2024-02-29, 21:15authored byAlessandro Zulli, Meri R.J. Varkila, Julie Parsonnet, Marlene K. Wolfe, Alexandria B. Boehm
Respiratory syncytial virus (RSV) is a leading cause
of respiratory
illness and hospitalization, but clinical surveillance detects only
a minority of cases. Wastewater surveillance could determine the onset
and extent of RSV circulation in the absence of sensitive case detection,
but to date, studies of RSV in wastewater are few. We measured RSV
RNA concentrations in wastewater solids from 176 sites during the
2022–2023 RSV season and compared those to publicly available
RSV infection positivity and hospitalization rates. Concentrations
ranged from undetectable to 107 copies per gram. RSV RNA
concentration aggregated at state and national levels correlated with
infection positivity and hospitalization rates. RSV season onset was
determined using both wastewater and clinical positivity rates using
independent algorithms for 14 states where both data were available
at the start of the RSV season. In 4 of 14 states, wastewater and
clinical surveillance identified RSV season onset during the same
week; in 3 states, wastewater onset preceded clinical onset, and in
7 states, wastewater onset occurred after clinical onset. Wastewater
concentrations generally peaked in the same week as hospitalization
rates but after case positivity rates peaked. Differences in onset
and peaks in wastewater versus clinical data may reflect inherent
differences in the surveillance approaches.