RespiratoryVirus Season Surveillance in the UnitedStates Using Wastewater Metrics, 2023–2024

Wastewater measurements represent an entire contributing population and can be available within 24 h. Enhanced information about disease occurrence can improve population health through better timing of policies and interventions. We aimed to infer seasonal occurrence patterns for common respiratory viruses alongside transmission dynamics for SARS-CoV-2 across the USA using wastewater samples. We used wastewater RNA concentrations of influenza A and B (IAV/IBV), respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and SARS-CoV-2 from 175 treatment plants (July 2023–June 2024). For IAV, IBV, RSV, and HMPV, we determined epidemic onset, offset, peak, and duration at national and subnational scales. For SARS-CoV-2, we categorized wastewater measurements based on recent wastewater levels and trends. Epidemic onset occurred in November for IAV and RSV which aligned with prepandemic norms. Onset occurred in January for IBV and April for HMPV which were later than expected according to historical data. Duration was longer for IAV and shorter for IBV, RSV, and HMPV than expected based on historical data. Epidemic peak dates were consistent with prepandemic norms for all viruses. Peak dates for influenza and RSV coincided with high, upward trending SARS-CoV-2 RNA concentrations, suggesting potential co-occurrence of SARS-CoV-2 with these viruses.