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Expanded Use of Wastewater-Based Surveillance Unveils Emerging Flu and RSV Trends


•    Wastewater-based surveillance of influenza A, influenza B and respiratory syncytial virus positivity rates correlated closely with reported clinical cases in Calgary, Canada, according to new study findings.
•    The study analyzes wastewater-based surveillance for common seasonal respiratory viruses beyond SARS-CoV-2.
•    Broader use of wastewater-based surveillance can indicate viral trends, illuminate hot spots and prepare communities for potential flu and RSV outbreaks.


Wastewater-based surveillance can accurately monitor influenza A and B and RSV at the population level, making it an objective tool to inform public response to common seasonal illnesses, according to research presented at IDWeek 2023. 

The study found that viral signals in Calgary’s wastewater correlated with weekly confirmed clinical cases for all three viruses. Influenza A peaked in Calgary’s wastewater between November-December 2022; influenza B between February-April 2023; and RSV between November 2022-February 2023. 

The data come from weekly collections of 24-hour composite wastewater samples from three treatment plants in Calgary between March 2022 and April 2023. The wastewater values were compared to clinical data reported by Alberta Health Services and reported as total cases and test positivity rates across Calgary and Alberta. 

“Just one flush can hold a lot of 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,” said Kristine Du, BSc, lab technician at the Cumming School of Medicine at University of Calgary and presenting author. “Knowing what viruses are coming down the pike can help prepare individuals and communities appropriately.”  

Researchers say the results provide a novel surveillance approach that can exist independent to and complementary of clinical testing, enabling detection of common seasonal respiratory viruses, an important step that builds off wastewater surveillance that rose in prominence during the COVID-19 pandemic. Understanding community-level viral trends can identify hot spots, inform local public health decision making and prepare clinicians and hospitals for potential outbreaks.

Moving forward, researchers say that onboarding additional respiratory viruses to wastewater surveillance capabilities will help 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.

About IDWeek
IDWeek is the joint annual meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. IDWeek is a recognized forum for peer-reviewed presentations of new research on scientific advances and bench-to-bedside approaches in prevention, diagnosis, treatment and epidemiology of infectious diseases, including HIV, across the lifespan. For more information, visit

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