Epidemiological surveillance of respiratory pathogens in wastewater in Belgium

ABSTRACT Background Detailed information on the circulation of respiratory viruses in the community is crucial to gain better understanding of the burden of respiratory infections on society. Methods By using an in-house respiratory panel for simultaneous detection of 29 respiratory pathogens (22 viruses and 7 bacteria/fungi), we explored the possibility to use wastewater sampling to monitor the circulation of respiratory pathogens at population level. Results We were able to detect all respiratory viruses included in the panel (influenza A, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), parainfluenza viruses (PIV) 1-4, adenovirus (Adv), human bocavirus (HBoV), enterovirus/rhinovirus (EV/RV), enterovirus D68 (EV-D68), parechovirus (HPeV), human coronaviruses (HCoV)-NL63, -229E, -OC43, -HKU-1 and -SARS, cytomegalovirus (CMV) and herpes simplex virus (HSV)-1 and -2), except for influenza B and HCoV MERS which were not circulating in Belgium during the two year study period. An upsurge of EV-D68 infections in Europe in September 2021 was clearly reflected in the wastewater samples. For the viruses where epidemiological data on virus circulation in Belgium were available, these matched the wastewater data. The wastewater pretreatment that was used, optimized for viral enrichment, was as such not suited for the surveillance of bacteria and fungi. Conclusions Community circulation levels of respiratory viruses were well reflected in wastewater samples, indicating that wastewater-based epidemiology can be a valuable tool in the epidemiology and management of respiratory infections.