{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:01:35Z","timestamp":1787162495278,"version":"build-2736575974"},"reference-count":15,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Hellenic National Public Health Organization (NPHO)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The emergence of the COVID-19 pandemic has led to significant progress in the field of wastewater-based surveillance (WBS) of respiratory pathogens and highlighted its potential for a wider application in public health surveillance. This study aimed to evaluate whether monitoring of respiratory syncytial virus (RSV) in wastewater can provide a comprehensive picture of disease transmission at the community level. The study was conducted in Larissa (Central Greece) between October 2022 and January 2023. Forty-six wastewater samples were collected from the inlet of the wastewater treatment plant of Larissa and analyzed with a real-time reverse transcription polymerase chain reaction (RT-PCR) based method. RSV and SARS-CoV-2 wastewater viral loads (genome copies\/100,000 inhabitants) were analyzed against sentinel surveillance data on influenza-like illness (ILI) to identify potential associations. Univariate linear regression analysis revealed that RSV wastewater viral load (lagged by one week) and ILI notification rates in children up to 14 years old were strongly associated (std. Beta: 0.73 (95% CI: 0.31\u20131.14), p = 0.002, R2 = 0.308). A weaker association was found between SARS-CoV-2 viral load and ILI rates in the 15+ age group (std. Beta: 0.56 (95% CI: 0.06\u20131.05), p = 0.032, R2 = 0.527). The results support the incorporation of RSV monitoring into existing wastewater-based surveillance systems.<\/jats:p>","DOI":"10.3390\/ijerph20065219","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T07:09:31Z","timestamp":1679468971000},"page":"5219","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Wastewater Levels of Respiratory Syncytial Virus Associated with Influenza-like Illness Rates in Children\u2014A Case Study in Larissa, Greece (October 2022\u2013January 2023)"],"prefix":"10.3390","volume":"20","author":[{"given":"Michalis","family":"Koureas","sequence":"first","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Str., 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0065-5766","authenticated-orcid":false,"given":"Kassiani","family":"Mellou","sequence":"additional","affiliation":[{"name":"National Public Health Organization, 15123 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5424-0235","authenticated-orcid":false,"given":"Alexandros","family":"Vontas","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Str., 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4689-4623","authenticated-orcid":false,"given":"Maria","family":"Kyritsi","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Str., 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Panagoulias","sequence":"additional","affiliation":[{"name":"National Public Health Organization, 15123 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Koutsolioutsou","sequence":"additional","affiliation":[{"name":"National Public Health Organization, 15123 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2535-3596","authenticated-orcid":false,"given":"Varvara A.","family":"Mouchtouri","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Str., 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1287-7734","authenticated-orcid":false,"given":"Matthaios","family":"Speletas","sequence":"additional","affiliation":[{"name":"Department of Immunology and Histocompatibility, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6167-7152","authenticated-orcid":false,"given":"Dimitrios","family":"Paraskevis","sequence":"additional","affiliation":[{"name":"National Public Health Organization, 15123 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4769-8376","authenticated-orcid":false,"given":"Christos","family":"Hadjichristodoulou","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 22 Papakyriazi Str., 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/S0140-6736(10)60206-1","article-title":"Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: A systematic review and meta-analysis","volume":"375","author":"Nair","year":"2010","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1016\/S0140-6736(22)00478-0","article-title":"Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: A systematic analysis","volume":"399","author":"Li","year":"2022","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s12016-013-8368-9","article-title":"Respiratory Syncytial Virus\u2014A Comprehensive Review","volume":"45","author":"Borchers","year":"2013","journal-title":"Clin. Rev. Allerg. Immunol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"T\u00f6r\u00f6k, E., Cooke, F.J., and Moran, E. (2017). Oxford Handbook of Infectious Diseases and Microbiology, Oxford University Press. [2nd ed.].","DOI":"10.1093\/med\/9780199671328.001.0001"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1900157","DOI":"10.2807\/1560-7917.ES.2019.24.40.1900157","article-title":"Current practices for respiratory syncytial virus surveillance across the EU\/EEA Member States, 2017","volume":"24","author":"Mollers","year":"2019","journal-title":"Eurosurveillance"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"xtad003","DOI":"10.1093\/femsmc\/xtad003","article-title":"Show us the Data: Global COVID-19 Wastewater Monitoring Efforts, Equity, and Gaps","volume":"4","author":"Naughton","year":"2023","journal-title":"FEMS Microbes"},{"key":"ref_7","unstructured":"European Commission (2023, February 10). Proposal for a Directive of the European Parliament and of the Council Concerning Urban Wastewater Treatment (Recast), Available online: https:\/\/environment.ec.europa.eu\/publications\/proposal-revised-urban-wastewater-treatment-directive_en."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"111749","DOI":"10.1016\/j.envres.2021.111749","article-title":"Wastewater monitoring as a supplementary surveillance tool for capturing SARS-COV-2 community spread. A case study in two Greek municipalities","volume":"200","author":"Koureas","year":"2021","journal-title":"Environ. Res."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Suwa, R., Kume, Y., Kawase, M., Chishiki, M., Ono, T., Norito, S., Sato, K., Okamoto, M., Kumaki, S., and Nagai, Y. (2022). Practical Validation of United States Centers for Disease Control and Prevention Assays for the Detection of Human Respiratory Syncytial Virus in Pediatric Inpatients in Japan. Pathogens, 11.","DOI":"10.3390\/pathogens11070754"},{"key":"ref_10","unstructured":"National Public Health Organization (NPHO) (2023, February 12). Weekly Report of Epidemiological Surveillance of Respiratory Infections Week 02\/2023 (9 January 2023\u201315 January 2023) [Internet], Available online: https:\/\/eody.gov.gr\/wp-content\/uploads\/2023\/01\/anapneustikon-ion-report-2023-02.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1002\/jmv.24430","article-title":"Respiratory syncytial virus activity and climate parameters during a 12-year period","volume":"88","author":"Sirimi","year":"2016","journal-title":"J. Med. Virol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3453","DOI":"10.1002\/jmv.27671","article-title":"Early initiation of the respiratory syncytial virus season in 2021\u20132022, Greece","volume":"94","author":"Pappa","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1021\/acs.estlett.1c00963","article-title":"Respiratory Syncytial Virus (RSV) RNA in Wastewater Settled Solids Reflects RSV Clinical Positivity Rates","volume":"9","author":"Hughes","year":"2022","journal-title":"Environ. Sci. Technol. Lett."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"161023","DOI":"10.1016\/j.scitotenv.2022.161023","article-title":"Occurrence of multiple respiratory viruses in wastewater in Queensland, Australia: Potential for community disease surveillance","volume":"864","author":"Ahmed","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111145","DOI":"10.1016\/j.jtbi.2022.111145","article-title":"Distinguishing viruses responsible for influenza-like illness","volume":"545","author":"Spencer","year":"2022","journal-title":"J. Theor. Biol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/5219\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:00:30Z","timestamp":1760122830000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/5219"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,22]]},"references-count":15,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20065219"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20065219","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,22]]}}}