Project Details

Wastewater-based surveillance for monitoring Respiratory Syncytial Virus circulation

Meri Varkila, MD

Summary

BACKGROUND: Respiratory Syncytial Virus (RSV) is a common seasonal respiratory virus that causes acute respiratory infection with an increased risk of severe disease in the first 6 months of life. In the U.S., RSV is the leading cause of infant hospitalization and, globally, RSV infections constitute the second most common cause of infant mortality. GAP: Successful and cost-effective implementation of RSV vaccination will be determined by the ability to align maternal and neonatal immunization with the onset of the RSV season. However, current clinical RSV surveillance systems do not account for undertesting and may not capture the full extent of RSV circulation over the course of the RSV season. HYPOTHESIS: Wastewater-based epidemiology can identify increases in RSV circulation by measuring changes in RSV wastewater concentrations and can provide accurate and unbiased estimates of RSV activity within communities. METHODS: We will assess the epidemiology of RSV in the U.S. using wastewater data on RSV from Stanford’s Wastewater SCAN program, a nationwide initiative that monitors infectious diseases, through municipal sewage systems from over 180 sites across 36 states. We will perform geospatial analysis of RSV circulation in 2022-2024 and establish metrics for wastewater-based surveillance of RSV that could be readily applied within existing wastewater monitoring initiatives to identify sustained and notable trends in RSV activity and quantify the magnitude of RSV transmission in communities. RESULTS: RSV concentrations in wastewater during 2022-2023 season parallel traditional disease metrics, such as positivity and hospitalization rates (Zulli, Varkila, et al. ACS EST Water 2024). IMPACT: Methods developed from this study can enhance RSV surveillance, guide implementation of preventive measures, and ultimately be used to evaluate the real-world impact of RSV immunization programs on a disease that disproportionately harms those most vulnerable, particularly children under 2.