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Emerg Infect Dis . Correlations between Wastewater Concentrations of Influenza A and Respiratory Syncytial Viruses and Clinical Laboratory Testing an

tetano

Editor, Senior Moderator
Emerg Infect Dis

. 2026 Aug;32(13):53-65.
doi: 10.3201/eid3213.260306.

Correlations between Wastewater Concentrations of Influenza A and Respiratory Syncytial Viruses and Clinical Laboratory Testing and Hospitalization Data, California, USA​


Elisabeth Burnor, Madhura S Rane, Marisa A P Donnelly, Lauren A White, Cora Hoover, Monica Sun, Caroline Collins, Andrew Abram, Mariah Otstot, Joel Rojas, Cody Berkobien, Seema Jain, Duc J Vugia, Wayne T A Enanoria, Linlin Li, Chad Below, Marlene Wolfe, Alexandria B Boehm, Tomás M León, Erin L Murray, Alexander T Yu



Free article

Abstract​


We evaluated correlations between influenza A virus and respiratory syncytial virus (RSV) wastewater concentrations in California, USA, and 3 clinical laboratory-based disease surveillance datasets: sentinel laboratory surveillance, mandatory electronic laboratory reporting data, and laboratory-confirmed influenza hospitalizations. We evaluated data from 10 counties and 18 wastewater treatment plants in California during July 2022-March 2024. We observed strong, positive, and statistically significant correlations between individual sewershed-level wastewater concentrations and county-aggregated wastewater concentrations of influenza A and RSV and clinical laboratory-based surveillance datasets (median Kendall τ 0.62 [range 0.40-0.78]; p<0.05). A lead-lag analysis did not show consistent evidence of wastewater leading other surveillance datasets across all counties and wastewater treatment plants (influenza A -16 to 22 days; RSV -8 to 35 days). Wastewater surveillance can augment other disease surveillance modalities and improve situational awareness of influenza A and RSV transmission in communities.

Keywords: California; Influenza; RSV; United States; respiratory infections; respiratory syncytial virus; viruses; wastewater-based epidemiological monitoring.
 
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