A Correlation Study of Acute Respiratory Virus Detection in Wastewater and National Sentinel Surveillance

Effective surveillance of acute respiratory viruses (ARVs) is crucial for timely public health action, yet sentinel systems have intrinsic gaps in coverage and reporting timeliness.Wastewater-based epidemiology (WBE) can complement sentinel networks by capturing population-level viral circulation regardless of healthcareseeking behavior.We conducted a correlation study between ARV detections in influent wastewater and national sentinel surveillance in Korea.From September 2023 to August 2024, 295 influent samples collected weekly from six wastewater treatment plants in Busan were tested for eight ARVs by multiplex real-time RT-PCR, while nationwide sentinel case counts were analyzed in parallel.Adenovirus (81.4%) and human bocavirus (41.0%) were persistently detected, whereas influenza virus (27.8%) and human metapneumovirus (19.0%) showed clear seasonal peaks.Pearson correlation demonstrated strong agreement for human metapneumovirus(hMPV)(weekly r = 0.770; monthly r = 0.955; |r| 0.7), parainfluenza virus (PIV) (weekly r = 0.749;monthly r = 0.661), and influenza virus (IFV)(weekly r = 0.710; monthly r = 0.612), with moderate associations for huma bocavirus(hBoV).These results indicate that WBE reliably reflects temporal trends for clinically important ARVs and can augment sentinel surveillance.Correlation patterns also help identify ARVs most suitable for wastewater monitoring, informing prioritization in public health applications.