RSV concentration in wastewater and trends among incident hospitalizations in children and older adults
Application: Wastewater-Based Surveillance | Respiratory Syncytial Virus (RSV) | Public Health Early Warning
Technology: Nanotrap® Microbiome Particles
Publication: Hill DT, Laplante J, Byun S, et al. RSV concentration in wastewater and trends among incident hospitalizations in children and older adults. medRxiv. Posted July 23, 2026.
Overview
A new study conducted by researchers at Syracuse University, the New York State Department of Health, and the University at Buffalo demonstrates the potential of wastewater surveillance to predict respiratory syncytial virus (RSV) hospitalizations among older adults.
Researchers analyzed 2,662 wastewater samples collected from 24 wastewater treatment sites across four New York counties between September 2022 and July 2024. By comparing RSV concentrations in wastewater with reported clinical cases and hospitalizations, the study demonstrated strong correlations between wastewater viral levels and community disease burden.
Importantly, RSV concentrations in wastewater preceded hospitalizations among adults over 50 by up to two weeks, highlighting the potential of wastewater-based epidemiology to provide actionable early warning for vulnerable populations.
Ceres Nanosciences' Nanotrap® Microbiome Particles were used to concentrate viral material from wastewater samples collected in Erie County, supporting an automated sample preparation workflow for RSV detection and quantification.
These findings reinforce the value of sensitive wastewater surveillance technologies for monitoring respiratory pathogens, forecasting disease burden, and informing public health preparedness.
Study Highlights
Large-scale surveillance: 2,662 wastewater samples analyzed across 24 treatment sites in four New York counties over two respiratory seasons.
Strong clinical correlations: RSV wastewater concentrations correlated with reported hospitalizations, with Spearman correlation coefficients ranging from 0.63 to 0.85 across counties.
Early warning for older adults: Wastewater RSV concentrations preceded hospitalizations among adults over 50 by up to two weeks.
Strong predictive performance: A wastewater-based statistical model achieved an R² of 0.88 for predicting RSV hospitalizations among adults over 50 at a two-week lead.
Age-specific surveillance insights: Wastewater signals lagged hospitalizations among children under 10 by approximately three weeks, demonstrating important differences in infection and transmission dynamics.
Automated Nanotrap workflow: Nanotrap Microbiome Particles were incorporated into an automated viral concentration and nucleic acid extraction workflow for Erie County wastewater samples.
Nanotrap Technology in Action
Researchers evaluated RSV concentrations in wastewater collected across Erie, Jefferson, Onondaga, and Westchester counties as part of the New York State Wastewater Surveillance Network.
Two sample concentration approaches were employed. Samples from three counties were processed using ultracentrifugation, while researchers at the University at Buffalo used Nanotrap Microbiome A Particles to concentrate viral material from Erie County wastewater samples.
The Nanotrap workflow combined approximately 10 mL of wastewater with Nanotrap Enhancement Reagent 1 and Nanotrap Microbiome A Particles. Viral concentration and subsequent nucleic acid extraction were performed using the Thermo Fisher Scientific KingFisher™ Apex Purification System and MagMAX™ reagents.
Extracted nucleic acids were analyzed using a multiplex digital reverse transcription PCR assay targeting RSV and influenza A.
Erie County demonstrated the highest average RSV wastewater detection rate among the four counties, approximately 41% across the full study period, increasing to approximately 57% during respiratory virus season.
The study also reported the highest observed RSV concentration in Erie County, reaching 165.23 gene copies/mL, compared with maximum concentrations ranging from approximately 18 to 85 gene copies/mL in counties using ultracentrifugation.
The researchers suggested that differences in detected viral concentrations could potentially reflect greater sensitivity of the magnetic particle-based preparation method, while emphasizing that additional studies are needed to confirm this interpretation.
Although the study was not designed as a direct head-to-head comparison of concentration technologies, it demonstrates the successful integration of Nanotrap technology into a large-scale respiratory virus surveillance program.
Key Findings
Performance Measure | Study Finding |
Wastewater samples analyzed | 2,662 across four New York counties |
Surveillance period | September 2022–July 2024 |
RSV wastewater–hospitalization correlation | Spearman ρ = 0.63–0.85 |
Early warning for adults over 50 | Up to 2 weeks |
Predictive model performance | R² = 0.88 at a two-week lead |
Highest county-level RSV detection rate | Erie County, approximately 41% annually |
Nanotrap application | Automated viral concentration and nucleic acid extraction in Erie County |
Maximum RSV concentration in Erie County | 165.23 gene copies/mL |
The findings demonstrate that wastewater surveillance can provide valuable epidemiological information beyond conventional clinical testing, particularly when results are analyzed in relation to specific at-risk populations.
While wastewater RSV signals did not provide advance warning of pediatric hospitalizations, they showed meaningful predictive value for hospitalizations among older adults.
This distinction highlights the importance of understanding pathogen-specific transmission patterns when developing wastewater-based early warning systems.
Significance
This study provides additional evidence supporting wastewater surveillance as a valuable tool for monitoring respiratory disease transmission and anticipating healthcare demand.
RSV represents a significant public health challenge, particularly among infants, young children, and older adults. Traditional clinical surveillance can be limited by testing practices, reporting delays, and incomplete coverage of community infections.
Wastewater surveillance offers a complementary, population-level approach that does not depend on individual clinical testing or diagnosis.
By demonstrating that RSV wastewater concentrations can anticipate hospitalizations among older adults by up to two weeks, this research highlights opportunities for public health agencies to improve respiratory disease forecasting, allocate healthcare resources, and implement targeted interventions for vulnerable populations.
The incorporation of Nanotrap Microbiome Particles into the Erie County surveillance workflow further demonstrates the applicability of automated magnetic particle-based concentration technology for monitoring respiratory pathogens in complex wastewater samples.
As wastewater surveillance programs expand beyond SARS-CoV-2 to include RSV, influenza, and other infectious diseases, reliable and scalable sample preparation technologies will remain an important component of effective surveillance infrastructure.
These findings reinforce the potential of Nanotrap-enabled wastewater surveillance to help public health agencies reveal emerging disease trends, strengthen outbreak preparedness, and make more informed decisions to protect community health.
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