Research Area: Wastewater-Based Epidemiology (WBE)

Monitoring Respiratory Syncytial Virus (RSV) through wastewater: A promising public-health tool

Posted on by Stephanie Leisso

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.
At GT Molecular, we’re proud to lead in wastewater surveillance and pathogen detection. Our cutting-edge technologies empower communities to monitor key pathogens in real time and stay one step ahead of outbreaks. With our RSV detection kits and testing services, we’re transforming wastewater into a public health signal, protecting the most vulnerable.

Integrating pertussis detection into wastewater workflows

Posted on by Stephanie Leisso

The recent resurgence of Bordetella pertussis, commonly known as whooping cough, has become a significant public health concern. In 2024, the United States saw a dramatic increase in reported cases (CDC, 2025). Tracking the spread and resurgence of this disease through clinical cases alone can fail to capture the full scope of community transmission due to diagnostic lags and varying healthcare access.  Wastewater-based epidemiology (WBE) offers a complimentary surveillance approach, providing real-time community-level insights.

WBE as a sentinel for outbreak management

Recent studies have demonstrated that existing wastewater surveillance networks can be effectively leveraged to track B. pertussis outbreaks. During a 2023 outbreak in Alberta, Canada, researchers successfully detected the pathogen in wastewater, with trends strongly correlating with aggregated clinical case data (Weyant et al., 2025). This finding reinforces the use of wastewater surveillance in providing valuable information, particularly when clinical surveillance is sparse or delayed.

By capturing shedding from both symptomatic and asymptomatic individuals, WBE provides an early warning system for emerging outbreaks. This allows public health officials to proactively allocate resources, such as targeted vaccination clinics or public health alerts, before clinical cases peak.

Efficiency through multiplexed panels

A significant challenge for laboratories is the logistical burden of adding new targets to an already dense surveillance schedule. The GT-Digital™ Bordetella pertussis Wastewater Surveillance Assay v1.0 for the QIAGEN® QIAcuity® Digital PCR System (Cat# 101125) and the GT-Digital™ Bordetella pertussis Wastewater Surveillance Assay v1.0 for the Bio-Rad QX200™ or QX600™ Droplet Digital™ PCR System (Cat# 101130) can be seamlessly multiplexed with targets in other channels. This strategy can save valuable resources and allow labs to attain higher reproducibility by minimizing consumables and users.

Strengthening the public health safety net

Expanding routine wastewater monitoring to include pertussis is a proactive investment in community resilience. By leveraging the same molecular infrastructure established for COVID-19 and Influenza, labs can provide a more comprehensive safety net that adapts dynamically to emerging public health threats in real time.

This integrated approach strengthens community-level surveillance and supports more agile, data-driven public health decisions.

At GT Molecular, we are committed to advancing molecular tools that support wastewater surveillance and pathogen detection. Our technologies empower communities to stay ahead of outbreaks and protect vulnerable populations.

Why do Influenza A and B in wastewater matter?

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Community-level surveillance

Studies have demonstrated that Influenza A RNA is reliably detectable in wastewater, while Influenza B is detectable but generally at lower concentrations. For example:

  • A study of 100 samples from wastewater treatment plants in Karnataka, India found 18% positive for influenza A and 2% for influenza B, with detectable loads. (Panneerselvam, et al.)
  • Another investigation demonstrated that concentrations of influenza A and B in wastewater followed trends observed in clinical laboratory data. (Boehm, et al.)

Thus, wastewater viral signals can serve as a leading indicator of influenza circulation, potentially giving public‐health authorities earlier warning of rising activity.

Integration of human and animal/zoonotic signals (One Health)

Influenza A viruses have zoonotic potential. For instance, the highly pathogenic avian influenza (HPAI) A(H5N1) outbreak among dairy cattle and poultry in the U.S. prompted wastewater surveillance; detection of H5 subtype RNA in wastewater aligned with animal outbreaks (Louis, et al.).

Wastewater signals thus might capture inputs from human excretion and from animal sources (via animal waste, farm runoff, milk processing, wild birds). This provides a broader view of influenza virus ecology and spill‐over risk.

Early‐warning and preparedness

Wastewater integrates signals from symptomatic, asymptomatic, and untested individuals, providing a more complete picture of population-level infection, therefore WBE can provide advance notice of rising transmission or unusual viral activity (e.g., a novel strain, bovine/poultry spill-over). For example, one study reported a 17-day lead time in forecasting a city‐wide outbreak of influenza via wastewater subtyping (Mercier, et al.).

Such lead time can support public-health stakeholders to ramp up diagnostics, vaccination campaigns, and communicate risks.

What are the implications of wastewater surveillance for Influenza A & B?

Vaccine and resource planning

Early signals of rising influenza viral load in wastewater can inform decisions on vaccination campaigns (timing, scale), hospital readiness (stockpiling antivirals, ICU capacity), and public messaging (e.g., encouraging immunization, hygiene).

Research and emerging pathogens

Although sequencing influenza from wastewater remains technically challenging, improving workflows may enable earlier detection of new variants and reassortments before they are widely identified in clinical settings (Mercier, et al.).

Tools like the GT Molecular GT‑Fast Prep Influenza A Library Kit for Illumina® are accelerating this progress by enabling targeted amplicon sequencing of the most important circulating subtypes (H1N1 and H3N2). By providing more sensitive and subtype‑specific genomic data directly from wastewater, these kits help generate actionable insights on flu variant dynamics and further bridge the gap between environmental surveillance and real‑time public health decision‑making.

A new frontier in public health

Although influenza tends to appear at lower concentrations in wastewater than enteric viruses, consistent detection across systems demonstrates that wastewater-based epidemiology is effective for community-level disease tracking.

Wastewater surveillance is proving that the pipes beneath our cities aren’t just carrying away waste, they’re carrying valuable health information. With continued research and integration into public health systems, keeping an eye on our sewers could soon become one of the smartest ways to stay ahead of the flu.

GT Molecular provides digital PCR assays optimized for wastewater matrices, including panels targeting Influenza A and B. These tools support routine surveillance, outbreak detection, and monitoring to help communities stay ahead of seasonal and emerging influenza activity.

GT Molecular provides digital PCR assays optimized for wastewater matrices, including panels targeting Influenza A and B.  The GT Molecular Influenza A NGS Library Prep Kit provides further insights into circulating subtypes. These tools support routine surveillance, outbreak detection, and monitoring to help communities stay ahead of seasonal and emerging influenza activity.

Enterovirus-68: Why is it a public health risk? How can wastewater-based epidemiology identify outbreaks?

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What is Enterovirus D68?

EV-D68 is a non-polio enterovirus that often leads to very mild symptoms such as runny nose, sneezing, and mild coughing (Hixon et al, 2019; Non-Polio Enterovirus, CDC). Children, particularly those with asthma or other respiratory conditions, are at higher risk for complications.

In 2014, EV-D68 gained national attention due to its association with accute flacid myelitis (AFM). This neurological condition is rare and leads to weakness in limbs, as well as the loss of muscle tone and reflexes.  Most AFM cases occur in children, and there is no vaccine available against EV-D68.

Wastewater surveillance as a public health tool in the fight against EV-D68

EV-D68 outbreaks tend to follow a biennial pattern, with spikes observed in 2014, 2016, 2018, and again in 2022 and 2024 (Nguyen-Tran et al. 2025). These outbreaks have coincided with increases in AFM cases, prompting the CDC to initiate active surveillance programs. As such, 2026 may be another year with a spike in EV-D68 cases.

Key advantages of WBE for EV-D68:

  • Early Detection: Viral RNA from EV-D68 can be detected in wastewater before clinical cases are reported, allowing for proactive public health responses.
  • Community-Level Monitoring: WBE captures data from symptomatic and asymptomatic individuals, offering a more comprehensive view of virus circulation (Mangeri et al, 2025).
  • Cost-Effective Surveillance: Compared to individual testing, wastewater sampling is scalable and efficient.

In California, researchers tracked EV-D68 RNA in wastewater solids over 26 months. They found that viral concentrations spiked between July and December 2022, aligning with confirmed clinical cases and AFM diagnoses. Similar studies in Israel and Colorado have demonstrated strong correlations between wastewater data and clinical surveillance, reinforcing the value of multimodal monitoring. [wwwnc.cdc.gov] [mdpi.com], [wwwnc.cdc.gov]

Looking ahead: Strengthening public health preparedness

As EV-D68 continues to circulate and evolve, integrating wastewater surveillance into routine public health monitoring can enhance outbreak preparedness. These data can offer health authorities a better understanding of transmission dynamics and emerging strains and ultimately allow them to allocate resources effectively.

At GT Molecular, we are committed to advancing molecular tools that support wastewater surveillance and pathogen detection. Our technologies empower communities to stay ahead of outbreaks and protect vulnerable populations.

Hepatitis A (HAV) in wastewater: A vaccine preventable disease

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Why monitor Hepatitis A in wastewater?

Broad community‐level surveillance

  • HAV is excreted in feces of infected individuals, and thus viral particles (or viral RNA) can be present in wastewater influent. This makes WBE (Wastewater-Based Epidemiology) a feasible method for population-level monitoring. For example, one study found HAV RNA in raw sewage over an 8-month period in southern Italy (Morace, et al.).

Early warning and outbreak detection

  • Because wastewater aggregates signal from many individuals, possibly including asymptomatic infections, detection of HAV in wastewater could precede or at least complement clinical case detection, offering earlier insight into rising circulation.
    For instance:

    • A study during a hepatitis outbreak in Detroit found that HAV concentrations in wastewater correlated with reported case counts one week later (McCall et al.).
    • A longitudinal study examining wastewater in an urban city in Argentina found that HAV concentrations in the collected samples correlated with reported clinical trends for Hepatitis A. Genetic characterization of these samples found that the Hepatitis A lineages in wastewater were the same as those found in clinical cases at given time points (Fantilli et al.)

Monitoring equality and vulnerability

  • The association of wastewater HAV detection with socioeconomic vulnerability suggests the method can highlight disparities in disease burden. For example, the U.S. national study found that states with above-average rates of homelessness had ~48 % higher likelihood of HAV detection in wastewater (Zulli, et al.).

Complement to clinical surveillance

  • Traditional surveillance for hepatitis A relies on reported laboratory confirmed cases (anti-HAV IgM or HAV RNA), and on providers reporting to public-health bodies (Hepatitis A Surveillance Guidance, CDC).
  • Many mild or asymptomatic infections may go undetected, and people in vulnerable settings may have limited access to care and testing. Therefore, wastewater surveillance offers a complementary data stream which provides a non-biased, population-level signal, improving situational awareness.

Public health implications

  • Wastewater surveillance for HAV can help identify hidden or underreported transmission, especially in populations underserved or outside routine clinical surveillance (e.g., homeless shelters, food service workers).
  • Early detection via wastewater can enable timely public health interventions, such as targeted vaccination campaigns, improving hygiene/sanitation in high-risk settings, or food-safety inspections.
  • By linking wastewater HAV signals to socioeconomic vulnerability data, health authorities can drive equity-focused responses (e.g., prioritizing vaccination in communities with high homelessness or overdose-death rates).
  • As part of One Health/environmental health thinking, wastewater monitoring underscores that liver-infecting viruses transmitted by the fecal oral route (like HAV) leave detectable community-level signatures beyond clinical case numbers.

At GT Molecular, we translate wastewater surveillance into actionable insights, giving users the tools to detect pathogens early and respond before outbreaks escalate. Our HepA digital PCR kit helps public health teams monitor transmission proactively and protect vulnerable populations.