Nursing

Biology

Public health

Neighbourhood (mathematics)

Virology

Subtyping

Computer science

Outbreak

Environmental health

Coronavirus disease 2019 (COVID-19)

Mathematics

Microbiology

Population

Infectious disease (medical specialty)

Mathematical analysis

Medicine

Programming language

Virus

Pandemic

Influenza A virus

Disease

Typing

Pathology

Scientific Reports

Recurrent influenza epidemics and pandemic potential are significant risks to global health. Public health authorities use clinical surveillance to locate and monitor influenza and influenza-like cases and outbreaks to mitigate hospitalizations and deaths. Currently, global integration of clinical surveillance is the only reliable method for reporting influenza types and subtypes to warn of emergent pandemic strains. The utility of wastewater surveillance (WWS) during the COVID-19 pandemic as a less resource intensive replacement or complement for clinical surveillance has been predicated on analyzing viral fragments in wastewater. We show here that influenza virus targets are stable in wastewater and partitions favorably to the solids fraction. By quantifying, typing, and subtyping the virus in municipal wastewater and primary sludge during a community outbreak, we forecasted a citywide flu outbreak with a 17-day lead time and provided population-level viral subtyping in near real-time to show the feasibility of influenza virus WWS at the municipal and neighbourhood levels in near real time using minimal resources and infrastructure.

Municipal and neighbourhood level wastewater surveillance and subtyping of an influenza virus outbreak