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A recent study explored the correlation between respiratory syncytial virus levels in wastewater and influenza-like illness rates.

The emergence of the COVID-19 pandemic has spurred advancements in wastewater-based surveillance (WBS) of respiratory pathogens, offering potential applications in public health surveillance. 

This study, conducted in Larissa, Central Greece, assessed the benefits of monitoring respiratory syncytial virus (RSV) in wastewater for understanding disease transmission at the community level. RSV poses a significant threat, especially to young children, causing acute lower respiratory infections. The study’s findings were published in the International Journal of Environmental Research and Public Health.

Study Process 

Wastewater samples collected between October 2022 and January 2023 were analyzed using real-time reverse transcription polymerase chain reaction (RT-PCR). Correlations between RSV and SARS-CoV-2 wastewater viral loads and influenza-like illness (ILI) rates were examined. 

All wastewater samples were collected from Larissa’s wastewater treatment plant and analyzed using real-time RT-PCR. ILI rates were obtained from primary healthcare sentinel surveillance. 

Statistical analyses, including Spearman rank correlation coefficients and linear regression models, were employed to examine associations between wastewater viral loads and ILI rates.

Study Findings 

RSV wastewater concentrations peaked in December 2022, mirroring the rise in ILI rates among children up to 14 years old. Strong associations were found between RSV wastewater viral load (lagged by one week) and ILI notification rates in children up to 14 years old (std. Beta: 0.73, p = 0.002). A weaker association was observed between SARS-CoV-2 viral load and ILI rates in the 15+ age group (std. Beta: 0.56, p = 0.032). 

Bottom Line

Under-reporting and heterogeneity in RSV surveillance methods face challenges in accuracy and reporting consistency. The findings of this study underscore the potential of WBS for monitoring RSV outbreaks and enhancing targeted public health interventions. WBS is a cost-effective, unbiased, and efficient option that can accurately reveal the health status of communities. 

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 The study demonstrates a strong correlation between RSV wastewater levels and ILI rates among children, suggesting the effectiveness of WBS in tracking RSV transmission. These results advocate for RSV monitoring in existing wastewater-based surveillance systems to encourage improved public health preparedness. 

The results obtained highlight the importance of integrating RSV monitoring into existing wastewater-based surveillance systems, particularly focusing on areas with large pediatric populations. Timely detection of RSV outbreaks through WBS can enhance preparedness and guide public health strategies.

Wastewater-based surveillance for RSV offers valuable insights into community-level virus circulation.


Koureas, M., Mellou, K., Vontas, A., Kyritsi, M., Panagoulias, I., Koutsolioutsou, A., Mouchtouri, V. A., Speletas, M., Paraskevis, D., & Hadjichristodoulou, C. (2023). Wastewater Levels of Respiratory Syncytial Virus Associated with Influenza-like Illness Rates in Children—A Case Study in Larissa, Greece (October 2022–January 2023). International Journal of Environmental Research and Public Health, 20(6), 5219. https://doi.org/10.3390/ijerph20065219