Tracking Respiratory Syncytial Virus dynamics in wastewater during the 2024-2025 season in Switzerland

Respiratory Syncytial Virus (RSV) is responsible for a substantial health burden worldwide, particularly among children and older adults. In 2023, novel immunoprophylactic interventions for RSV were approved, underscoring the need to monitor circulating RSV lineages and detect mutations that could compromise intervention effectiveness. Here, we implemented wastewater-based genomic RSV surveillance by integrating digital PCR and amplicon-based sequencing within Switzerland's national wastewater monitoring program. We tracked RSV subtypes and individual mutations across the 2024-2025 peak season in six Swiss cities. RSV-A and RSV-B co-circulated nationwide, and both exhibited similar epidemiological dynamics estimated from their subtype-specific effective reproduction numbers. No previously reported F protein mutations relevant to prophylaxis efficacy were identified. Genetic diversity analysis of wastewater-derived sequences reflected patterns previously reported in clinical data, with higher diversity in RSV-A than RSV-B and greater variability in the G compared to the F gene. These findings demonstrate the potential of wastewater-based RSV surveillance for monitoring RSV dynamics and diversity and establish a national baseline for RSV evolution during the first season following vaccine implementation in Switzerland.