Respiratory Syncytial Virus (RSV) is a major cause of respiratory illness, particularly affecting infants, the elderly, and immunocompromised individuals (Respiratory syncytial virus, CDC). Traditional surveillance (clinical testing, hospitalizations, sentinel reporting) gives us valuable information, but it often lags actual viral spread. In recent years, wastewater-based epidemiology (WBE) has emerged as an important complementary surveillance method, and RSV is increasingly included in these programs (Wastewater Monitoring Program, CDC).
Why monitor RSV in wastewater?
Complement to clinical surveillance
Because not all infections are tested or recorded clinically, wastewater can provide an unbiased, aggregate measure of RSV presence in the community. For instance:
- In a Greek study in the city of Larissa, wastewater RSV viral loads (one-week lagged) were strongly associated with influenza-like-illness notification rates in children (Koreas M et al, 2023).
- In a JAMA article about three cities in Wisconsin, rises in wastewater levels of RSV (and influenza) preceded increases in emergency department visits (Harris E, 2023).
Implications for public health
- Early-warning capacity: Wastewater RSV monitoring offers potential early signals of rising viral circulation, supporting proactive measures in settings serving vulnerable populations (e.g., in paediatric units, elder-care facilities).
- Resource allocation & preparedness: Health systems can use upward trends in wastewater RSV to anticipate increased demand for hospital beds, respiratory support, or prophylactic therapies in high-risk populations.
- Season onset/offset tracking: Seasonal RSV epidemics vary geographically and temporally; wastewater monitoring adds another data stream to identify when the season starts/ends at a community level (Zhang Z, et al, 2025).
- One-health perspective and emerging pathogens: While RSV is primarily a human pathogen, the WBE infrastructure enables monitoring of other respiratory viruses, which may help detect emerging threats early.
Possible future directions
- Explore variant/lineage detection from wastewater for RSV (though currently less researched than for influenza or SARS-CoV-2). An example: a genomic surveillance study demonstrated identification of RSV lineages in wastewater in Northern Ireland (Allen DM et al, 2024).
- Sequencing RSV RNA from wastewater samples allows scientists to identify circulating strains, monitor trends, and detect emerging variants. This approach complements clinical surveillance, offering early warning of outbreaks and helping public-health officials respond more effectively.
