{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T03:39:27Z","timestamp":1790221167979,"version":"4.1.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018826","name":"Minist\u00e8re de l\u2019Environnement, de la Protection de la nature et des Parcs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>\n                    Seasonal influenza is an annual public health challenge that strains healthcare systems, yet population-level prevalence remains under-reported using standard clinical surveillance methods. Wastewater surveillance (WWS) of influenza A can allow for reliable flu surveillance within a community by leveraging existing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) WWS networks regardless of the sample type (primary sludge vs. primary influent) using an RT-qPCR-based viral RNA detection method for both targets. Additionally, current influenza A outbreaks disproportionately affect the pediatric population. In this study, we show the utility of interpreting influenza A WWS data with elementary student absenteeism due to illness to selectively interpret disease spread in the pediatric population. Our results show that the highest statistically significant correlation (R\n                    <jats:sub>s<\/jats:sub>\n                    = 0.96,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.011) occurred between influenza A WWS data and elementary school absences due to illness. This correlation coefficient is notably higher than the correlations observed between influenza A WWS data and influenza A clinical case data (R\n                    <jats:sub>s<\/jats:sub>\n                    = 0.79,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.036). This method can be combined with a suite of pathogen data from wastewater to provide a robust system for determining the causative agents of diseases that are strongly symptomatic in children to infer pediatric outbreaks within communities.\n                  <\/jats:p>","DOI":"10.3389\/fpubh.2023.1141136","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T14:43:33Z","timestamp":1690469013000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["An alternative method for monitoring and interpreting influenza A in communities using wastewater surveillance"],"prefix":"10.3389","volume":"11","author":[{"given":"Tomas","family":"de Melo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Golam","family":"Islam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denina B. D.","family":"Simmons","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Desaulniers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea E.","family":"Kirkwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"B1","unstructured":"Influenza Resources | IPAC Canada2020"},{"key":"B2","unstructured":"Flu, (influenza): FluWatch surveillance - Canada,.ca"},{"key":"B3","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1159\/000197314","article-title":"Influenza virus","volume":"36","author":"Bl\u00fcmel","year":"2009","journal-title":"Transfus Med Hemotherapy."},{"key":"B4","unstructured":""},{"key":"B5","unstructured":"COVID-19, wastewater surveillance dashboard - Canada,.ca"},{"key":"B6","doi-asserted-by":"publisher","first-page":"158967","DOI":"10.1016\/j.scitotenv.2022.158967","article-title":"Citywide wastewater SARS-CoV-2 levels strongly correlated with multiple disease surveillance indicators and outcomes over three COVID-19 waves","volume":"855","author":"Hopkins","year":"2023","journal-title":"Sci Total Environ."},{"key":"B7","unstructured":"Respiratory Viruses (including influenza) | Public Health Ontario"},{"key":"B8","doi-asserted-by":"publisher","first-page":"138764","DOI":"10.1016\/j.scitotenv.2020.138764","article-title":"First confirmed detection of SARS-CoV-2 in untreated wastewater in Australia: A proof of concept for the wastewater surveillance of COVID-19 in the community","volume":"728","author":"Ahmed","year":"2020","journal-title":"Sci Total Environ."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.15585\/mmwr.mm7144e2","article-title":"Public health response to a case of paralytic poliomyelitis in an unvaccinated person and detection of poliovirus in wastewater\u2014New York, June\u2013August 2022","volume":"71","author":"Link-Gelles","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"B10","doi-asserted-by":"publisher","first-page":"15777","DOI":"10.1038\/s41598-022-20076-z","article-title":"Municipal and neighbourhood level wastewater surveillance and subtyping of an influenza virus outbreak","volume":"12","author":"Mercier","year":"2022","journal-title":"Sci Rep."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1983","DOI":"10.1128\/aem.54.8.1983-1988.1988","article-title":"Polyethylene glycol precipitation for recovery of pathogenic viruses, including hepatitis A virus and human rotavirus, from oyster, water, and sediment samples","volume":"54","author":"Lewis","year":"1988","journal-title":"Appl Environ Microbiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/S2468-1253(20)30083-2","article-title":"Prolonged presence of SARS-CoV-2 viral RNA in faecal samples","volume":"5","author":"Wu","year":"2020","journal-title":"Lancet Gastroenterol Hepatol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"153228","DOI":"10.1016\/j.scitotenv.2022.153228","article-title":"Pasteurization, storage conditions and viral concentration methods influence RT-qPCR detection of SARS-CoV-2 RNA in wastewater","volume":"821","author":"Islam","year":"2022","journal-title":"Sci Total Environ."},{"key":"B14","doi-asserted-by":"publisher","first-page":"0108","DOI":"10.1371\/journal.pbio.0040003","article-title":"Viral community in human feces: Prevalence of plant pathogenic viruses","volume":"4","author":"Zhang","year":"2006","journal-title":"PLoS Biol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1373\/clinchem.2008.112797","article-title":"The MIQE Guidelines: Minimum Information for Publication of Quantitative Real-Time PCR Experiments","volume":"55","author":"Bustin","year":"2009","journal-title":"Clin Chem."},{"key":"B16","doi-asserted-by":"publisher","first-page":"150151","DOI":"10.1016\/j.scitotenv.2021.150151","article-title":"SARS-CoV-2 wastewater surveillance data can predict hospitalizations and ICU admissions","volume":"804","author":"Galani","year":"2021","journal-title":"Sci Total Environ"},{"key":"B17","doi-asserted-by":"publisher","first-page":"145319","DOI":"10.1016\/j.scitotenv.2021.145319","article-title":"Catching a resurgence: Increase in SARS-CoV-2 viral RNA identified in wastewater 48 h before COVID-19 clinical tests and 96 h before hospitalizations","volume":"770","author":"D'Aoust","year":"2021","journal-title":"Sci Total Environ."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1955","DOI":"10.1021\/acsestwater.1c00160","article-title":"Evaluation of sampling, analysis, and normalization methods for SARS-CoV-2 concentrations in wastewater to assess COVID-19 burdens in Wisconsin communities","volume":"1","author":"Feng","year":"2021","journal-title":"ACS ES&T Water."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1038\/s41587-020-0690-1","article-title":"Tracking COVID-19 with wastewater","volume":"38","author":"Larsen","year":"2020","journal-title":"Nat Biotechnol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"100098","DOI":"10.1016\/j.xcrm.2020.100098","article-title":"Temporal detection and phylogenetic assessment of SARS-CoV-2 in municipal wastewater","volume":"1","author":"Nemudryi","year":"2020","journal-title":"Cell Reports Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1038\/s41587-020-0684-z","article-title":"Measurement of SARS-CoV-2 RNA in wastewater tracks community infection dynamics","volume":"38","author":"Peccia","year":"2020","journal-title":"Nat Biotechnol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1002\/jmv.25795","article-title":"Detectable SARS-CoV-2 viral RNA in feces of three children during recovery period of COVID-19 pneumonia","volume":"92","author":"Zhang","year":"2020","journal-title":"J Med Virol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"150121","DOI":"10.1016\/j.scitotenv.2021.150121","article-title":"SARS-CoV-2 RNA concentrations in wastewater foreshadow dynamics and clinical presentation of new COVID-19 cases","volume":"805","author":"Wu","year":"2022","journal-title":"Sci Total Environ."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2038","DOI":"10.3201\/eid1711.110205","article-title":"Seasonal influenza A virus in feces of hospitalized adults","volume":"17","author":"Chan","year":"2011","journal-title":"Emerg Infect Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"434","DOI":"10.2166\/wh.2011.019","article-title":"Surveillance of influenza A and the pandemic influenza A (H1N1) 2009 in sewage and surface water in the Netherlands","volume":"9","author":"Heijnen","year":"2011","journal-title":"J Water Health."},{"key":"B26","doi-asserted-by":"publisher","first-page":"110946","DOI":"10.1016\/j.envres.2021.110946","article-title":"Unravelling the early warning capability of wastewater surveillance for COVID-19: A temporal study on SARS-CoV-2 RNA detection and need for the escalation","volume":"196","author":"Kumar","year":"2021","journal-title":"Environ Res."},{"key":"B27","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1097\/MPG.0000000000002798","article-title":"Prolonged fecal shedding of SARS-CoV-2 in pediatric patients. A quantitative evidence synthesis","volume":"71","author":"Santos","year":"2020","journal-title":"J Pediatr Gastroenterol Nutr."},{"key":"B28","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.jmii.2020.03.021","article-title":"Prolonged viral shedding in feces of pediatric patients with coronavirus disease 2019","volume":"53","author":"Xing YH Ni","year":"2020","journal-title":"J Microbiol Immunol Infect."},{"key":"B29","doi-asserted-by":"publisher","first-page":"5077","DOI":"10.1021\/acs.est.6b00876","article-title":"Survivability, partitioning, and recovery of enveloped viruses in untreated municipal wastewater","volume":"50","author":"Ye","year":"2016","journal-title":"Environ Sci Technol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1021\/acs.est.0c06191","article-title":"SARS-CoV-2 RNA in wastewater settled solids is associated with COVID-19 cases in a large urban Sewershed","volume":"55","author":"Graham","year":"2021","journal-title":"Environ Sci Technol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1126\/science.ade1675","article-title":"COVID-19 and children","volume":"377","author":"Pierce","year":"2022","journal-title":"Science."},{"key":"B32","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1097\/MOP.0000000000000495","article-title":"Influenza in children","volume":"29","author":"Kondrich","year":"2017","journal-title":"Curr Opin Pediatr."},{"key":"B33","first-page":"1","year":"2021","journal-title":"WHO information for the molecular detection of influenza viruses"},{"key":"B34","doi-asserted-by":"publisher","first-page":"11756","DOI":"10.1038\/s41598-022-15356-7","article-title":"Direct PCR with the CDC 2019 SARS-CoV-2 assay : optimization for limited\u2014resource settings","volume":"12","author":"Victoriano","year":"2022","journal-title":"Sci Rep."},{"key":"B35","doi-asserted-by":"publisher","first-page":"160685","DOI":"10.1016\/j.scitotenv.2022.160685","article-title":"Norovirus, Hepatitis A and SARS-CoV-2 surveillance within Chilean rural wastewater treatment plants based on different biological treatment typologies","volume":"863","author":"Plaza-Garrido","year":"2023","journal-title":"Sci Total Environ."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1141136\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T14:43:38Z","timestamp":1690469018000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1141136\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,27]]},"references-count":35,"alternative-id":["10.3389\/fpubh.2023.1141136"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1141136","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,27]]},"article-number":"1141136"}}