Wastewater-Based Detection of Two Influenza Outbreaks

Traditional influenza surveillance informs control strategies but can lag behind outbreak onset and undercount cases. Wastewater surveillance is effective for monitoring near real-time dynamics of outbreaks but has not been attempted for influenza. We quantified influenza A virus (IAV) RNA in wastewater during two active outbreaks on university campuses in different parts of the United States and during different times of year using case data from an outbreak investigation and high-quality surveillance data from student athletes. In both cases, the IAV RNA concentrations were strongly associated with reported IAV incidence rates (Kendall's tau values of 0.58 and 0.67 for the University of Michigan and Stanford University, respectively). Furthermore, the RNA concentrations reflected outbreak patterns and magnitudes. For the University of Michigan outbreak, evidence from sequencing IAV RNA from wastewater indicated the same circulating strain identified in cases during the outbreak. The results demonstrate that wastewater surveillance can effectively detect influenza outbreaks and will therefore be a valuable supplement to traditional forms of influenza surveillance.