High-Resolution Wastewater-Based Surveillance of Three Influenza Seasons (2022-2025) Reveals Distinct Seasonal Patterns of Viral Activity in Munich, Germany.

In the Northern Hemisphere, annual waves of influenza disease with varying degrees of spread and severity are observed each winter. With wastewater-based surveillance (WBS), including both centralized (one wastewater treatment plant, WWTP) and decentralized (three sewers) sampling, we aimed to detect differences in influenza viral copy numbers in wastewater over time, to investigate (sub)-community transmission within a city. A total of 313 grab/spot and composite samples were collected in Munich, Germany, during three consecutive influenza seasons (2022/23, 2023/24, and 2024/25) and were analyzed for influenza A virus (IAV) and influenza B virus (IBV) nucleic acids using digital droplet PCR (ddPCR). IAV and IBV wastewater copy numbers and citywide reported influenza cases showed strong correlations in both sampling approaches, suggesting the decentralized approach to be a reliable indicator of infection trends across the city. The three influenza seasons analyzed differed significantly in terms of their seasonal distribution, for example, exhibiting a strong co-circulation of IAV and IBV only in the 2024/25 season. Only with wastewater analysis, we reveal a reporting delay of influenza A cases at the beginning of the 2023/24 season. Higher influenza copy numbers were detected in sewer samples compared to the WWTP influent, likely due to viral decay. The study underscores the potential of influenza WBS to enable detection of seasonal onset early, identify local transmission patterns, and reveal underreporting in routine surveillance systems.