In this study, we conducted quantitative polymerase chain
reaction
(qPCR)-based wastewater surveillance for 12 prominent respiratory
pathogens in two northeastern cities of China, Dalian, and Benxi,
to understand the cocirculation patterns between COVID-19 and other
respiratory diseases from October 2022 to July 2023. Wastewater surveillance
revealed that Influenza A virus (IAV) and respiratory syncytial virus
(RSV) sewage concentrations exhibited an upward trend from October
2022 in both cities but with distinct epidemic trajectories. In Dalian,
IAV and RSV sewage concentrations both peaked in early December, followed
by a rapid decline since the emergence of COVID-19 on November 23,
2022. In Benxi, two bell-shaped curves were observed for IAV and RSV
sewage concentrations, both peaking in mid-December of 2022, even
though severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
emerged in wastewater on December 8, 2022. After a rapid decline in
SARS-CoV-2 sewage concentrations in January 2023, a new wave of IAV
in wastewater occurred between February and early April in both cities,
followed by a surge of SARS-CoV-2 RNA in early May. Meanwhile, an
out-of-season epidemic of RSV from March to May was observed in Benxi
based on the cities’ sewage concentrations. This study highlights
the impact of the timing of COVID-19 on the epidemic trajectories
of other respiratory diseases.