Correlation of Norovirus in Wastewater with Gastroenteritis-Related Hospitalizations, New York, USA, 2022-2024.

Norovirus is a substantial public health burden, yet surveillance is challenging because infections are underreported. Wastewater surveillance offers a complementary approach. We quantified norovirus genogroups GI and GII from 2,823 wastewater samples collected in New York, USA, during September 2022-July 2024. Across 4 counties in New York, we detected norovirus GI in 100% of samples and GII in 92%-100%. Both genogroups exhibited strong seasonal trends. During the study period, 499 norovirus-specific and 50,004 all-cause acute gastroenteritis hospitalizations occurred. Weekly correlations between GII concentrations and norovirus-specific hospitalizations showed moderate positive relationships (ρ = 0.23-0.28); GI concentrations showed weak correlations (ρ = -0.18 to 0.06). Correlations between norovirus in wastewater and all-cause acute gastroenteritis hospitalizations were weaker. Although wastewater surveillance reliably detects seasonal norovirus circulation in the population, correlations with hospitalizations were moderate. GII showed stronger associations with clinical outcomes than GI, supporting the importance of genogroup-specific monitoring.