Understanding transmission and infections of respiratory syncytial virus through wastewater-based epidemiology

Wastewater-based epidemiology (WBE) is an effective tool for tracking community circulation of respiratory viruses. We address a scientific gap that takes measured wastewater viral load of respiratory syncytial virus (RSV) and estimate the effective reproduction number and the number of infections in the population. We advocate a modular approach to the analysis. We first estimate the trend and current level of the RSV viral load and quantify the uncertainty. These estimates become input for our Bayesian renewal model for both the infection rate and the number of infected individuals. The modular approach simplifies the analysis pipeline while maintaining scientific integrity. Further, the modular approach supports translation to other viruses by using disease-specific models for estimated transmission and cases in the second phase of the analysis.