{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:04:43Z","timestamp":1790215483824,"version":"4.1.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In March 2024, the Centers for Disease Control and Prevention (CDC) released symptom-based isolation guidance for viral respiratory illnesses including influenza: isolation from others until fever-free for 24\u00a0h and other symptoms are improving, followed by 5\u00a0days of post-isolation precautions. This study evaluated how well these recommendations aligned with influenza virus RNA shedding and assessed self-reported isolation in a multi-site household study during 2023-2025. We analyzed data from 1294 participants with influenza, including 627 with a clear peak in viral RNA levels and symptom resolution during follow-up. Participants provided daily symptom diaries and nasal swabs. We used Kaplan\u2013Meier models to estimate recommended isolation duration based on CDC guidelines and compared this to viral RNA shedding measured by cycle threshold (Ct) values and viral loads (VLs). The median recommended isolation duration was 6\u00a0days (IQR 4-7). Peak viral RNA shedding occurred a median of 4\u00a0days post-symptom onset, falling during recommended isolation for 80% (by Ct) and 69% (by VL) of participants and increasing to 100% and 97%, respectively, by day 6 post-isolation. However, only 21% reported isolating from household members (median 2\u00a0days), and 80% isolated from the community (median 4\u00a0days). These findings support symptom-based isolation and emphasize the importance of post-isolation precautions.<\/jats:p>","DOI":"10.1093\/aje\/kwag219","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:47:13Z","timestamp":1789040833000},"source":"Crossref","is-referenced-by-count":0,"title":["Influenza mitigation recommendations, symptoms, and viral RNA shedding durations\u20142023-2024 and 2024-2025 seasons"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9242-3507","authenticated-orcid":false,"given":"Elizabeth B","family":"White","sequence":"first","affiliation":[{"name":"Influenza Division, Centers for Disease Control and Prevention , Atlanta, GA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline A","family":"O\u2019Neil","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa S","family":"Stockwell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York, NY ,","place":["United States"]},{"name":"Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center , New York, NY ,","place":["United States"]},{"name":"New York-Presbyterian Hospital , New York, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9947-588X","authenticated-orcid":false,"given":"Son H","family":"McLaren","sequence":"additional","affiliation":[{"name":"New York-Presbyterian Hospital , New York, NY ,","place":["United States"]},{"name":"Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Sano","sequence":"additional","affiliation":[{"name":"New York-Presbyterian Hospital , New York, NY ,","place":["United States"]},{"name":"Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celibell Y","family":"Vargas","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry C","family":"Fremont","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine , St. Louis, MO ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"House","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine , St. Louis, MO ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5469-0727","authenticated-orcid":false,"given":"Rachel M","family":"Presti","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine , St. Louis, MO ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie A","family":"Fritz","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine , St. Louis, MO ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos G","family":"Grijalva","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center , Nashville, TN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0141-1760","authenticated-orcid":false,"given":"H Keipp","family":"Talbot","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center , Nashville, TN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center , Nashville, TN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9849-1634","authenticated-orcid":false,"given":"Yuwei","family":"Zhu","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center , Nashville, TN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa A","family":"Scott","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center , Nashville, TN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney A","family":"Cornelison","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center , Nashville, TN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6702-8698","authenticated-orcid":false,"given":"Jessica E","family":"Biddle","sequence":"additional","affiliation":[{"name":"Influenza Division, Centers for Disease Control and Prevention , Atlanta, GA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A","family":"McNair","sequence":"additional","affiliation":[{"name":"Influenza Division, Centers for Disease Control and Prevention , Atlanta, GA ,","place":["United States"]},{"name":"STI Federal , Sault Ste. Marie, MI ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha G","family":"Dean","sequence":"additional","affiliation":[{"name":"Influenza Division, Centers for Disease Control and Prevention , Atlanta, GA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Bristol","sequence":"additional","affiliation":[{"name":"Influenza Division, Centers for Disease Control and Prevention , Atlanta, GA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra M","family":"Mellis","sequence":"additional","affiliation":[{"name":"Influenza Division, Centers for Disease Control and Prevention , Atlanta, GA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie H","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"2026092321213288900_ref1","volume-title":"Preventing Respiratory Illnesses","author":"CDC"},{"issue":"8","key":"2026092321213288900_ref2","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1038\/s41579-021-00535-6","article-title":"Transmissibility and transmission of respiratory viruses","volume":"19","author":"Leung","year":"2021","journal-title":"Nat Rev Microbiol"},{"issue":"4","key":"2026092321213288900_ref3","doi-asserted-by":"publisher","first-page":"CD006207","DOI":"10.1002\/14651858.CD006207.pub6","article-title":"Physical interventions to interrupt or reduce the spread of respiratory viruses","volume":"2023","author":"Jefferson","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"issue":"5&6","key":"2026092321213288900_ref4","doi-asserted-by":"publisher","first-page":"1615","DOI":"10.3934\/mbe.2013.10.1615","article-title":"Optimal strategies of social distancing and vaccination against seasonal influenza","volume":"10","author":"Shim","year":"2013","journal-title":"Math Biosci Eng"},{"key":"2026092321213288900_ref5","volume-title":"CDC Updates and Simplifies Respiratory Virus Recommendations","author":"CDC"},{"key":"2026092321213288900_ref6","volume-title":"Preventing Spread of Respiratory Viruses When You're Sick","author":"CDC"},{"issue":"10","key":"2026092321213288900_ref7","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1086\/652241","article-title":"Viral shedding and clinical illness in naturally acquired influenza virus infections","volume":"201","author":"Lau","year":"2010","journal-title":"J Infect Dis"},{"key":"2026092321213288900_ref8","volume-title":"Respiratory Virus Transmission Network for Influenza (RVTN-Flu)","author":"CDC"},{"issue":"4","key":"2026092321213288900_ref9","doi-asserted-by":"publisher","first-page":"e837","DOI":"10.1093\/infdis\/jiae278","article-title":"Household transmission and clinical features of respiratory tract infections that were SARS-CoV-2 positive and negative","volume":"230","author":"Ahti","year":"2024","journal-title":"J Infect Dis"},{"issue":"11","key":"2026092321213288900_ref10","doi-asserted-by":"publisher","first-page":"ofae591","DOI":"10.1093\/ofid\/ofae591","article-title":"Severe acute respiratory syndrome coronavirus 2 household transmission during the omicron era in Massachusetts: a prospective, case-ascertained study using genomic epidemiology","volume":"11","author":"Banga","year":"2024","journal-title":"Open Forum Infect Dis"},{"issue":"6","key":"2026092321213288900_ref11","doi-asserted-by":"publisher","first-page":"1522","DOI":"10.1093\/cid\/ciae069","article-title":"Household transmission dynamics of asymptomatic SARS-CoV-2-infected children: a multinational, controlled case-ascertained prospective study","volume":"78","author":"Funk","year":"2024","journal-title":"Clin Infect Dis"},{"issue":"3","key":"2026092321213288900_ref12","doi-asserted-by":"publisher","first-page":"e0118457","DOI":"10.1371\/journal.pone.0118457","article-title":"A household-based study of contact networks relevant for the spread of infectious diseases in the highlands of Peru","volume":"10","author":"Grijalva","year":"2015","journal-title":"PLoS One"},{"issue":"10","key":"2026092321213288900_ref13","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1093\/infdis\/jiac180","article-title":"SARS-CoV-2 virus dynamics in recently infected people-data from a household transmission study","volume":"226","author":"Mellis","year":"2022","journal-title":"J Infect Dis"},{"issue":"5","key":"2026092321213288900_ref14","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1093\/cid\/ciad696","article-title":"Symptoms, viral loads, and rebound among COVID-19 outpatients treated with Nirmatrelvir\/ritonavir compared with propensity score-matched untreated individuals","volume":"78","author":"Smith-Jeffcoat","year":"2024","journal-title":"Clin Infect Dis"},{"issue":"9","key":"2026092321213288900_ref15","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1093\/pnasnexus\/pgae338","article-title":"Influenza virus shedding and symptoms: dynamics and implications from a multiseason household transmission study","volume":"3","author":"Morris","year":"2024","journal-title":"PNAS Nexus"},{"issue":"7","key":"2026092321213288900_ref16","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1093\/aje\/kwm375","article-title":"Time lines of infection and disease in human influenza: a review of volunteer challenge studies","volume":"167","author":"Carrat","year":"2008","journal-title":"Am J Epidemiol"},{"issue":"4","key":"2026092321213288900_ref17","doi-asserted-by":"publisher","first-page":"e637","DOI":"10.1093\/infdis\/jiae591","article-title":"Asymptomatic and mildly symptomatic influenza virus infections by season: case-ascertained household transmission studies, United States, 2017\u20132023","volume":"232","author":"Biddle","year":"2025","journal-title":"J Infect Dis"},{"issue":"6","key":"2026092321213288900_ref18","doi-asserted-by":"publisher","first-page":"e394","DOI":"10.1016\/S1473-3099(23)00619-9","article-title":"The role of asymptomatic infections in influenza transmission: what do we really know","volume":"24","author":"Montgomery","year":"2024","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"2026092321213288900_ref19","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1038\/s44360-025-00049-y","article-title":"Frequent presymptomatic household transmission of influenza A but not influenza B virus","volume":"1","author":"Zhang","year":"2026","journal-title":"Nat Health"},{"issue":"33","key":"2026092321213288900_ref20","doi-asserted-by":"publisher","first-page":"e2304750120","DOI":"10.1073\/pnas.2304750120","article-title":"Reconstructing household transmission dynamics to estimate the infectiousness of asymptomatic influenza virus infections","volume":"120","author":"Tsang","year":"2023","journal-title":"Proc Natl Acad Sci"},{"key":"2026092321213288900_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2024.107291","article-title":"Non-pharmaceutical interventions to reduce influenza transmission in households: a systematic review and meta-analysis","volume":"150","author":"Wong","year":"2025","journal-title":"Int J Infect Dis"},{"issue":"10","key":"2026092321213288900_ref22","doi-asserted-by":"publisher","first-page":"1776","DOI":"10.1093\/cid\/ciab701","article-title":"Household transmission of severe acute respiratory syndrome coronavirus 2 in the United States: living density, viral load, and disproportionate impact on communities of color","volume":"74","author":"Cerami","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2026092321213288900_ref23","doi-asserted-by":"publisher","first-page":"100815","DOI":"10.1016\/j.epidem.2025.100815","article-title":"Estimating the generation time for influenza transmission using household data in the United States","volume":"50","author":"Chan","year":"2025","journal-title":"Epidemics"}],"container-title":["American Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/aje\/advance-article-pdf\/doi\/10.1093\/aje\/kwag219\/71019201\/kwag219.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/aje\/advance-article-pdf\/doi\/10.1093\/aje\/kwag219\/71019201\/kwag219.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T01:21:41Z","timestamp":1790212901000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/aje\/advance-article\/doi\/10.1093\/aje\/kwag219\/8789970"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":23,"URL":"https:\/\/doi.org\/10.1093\/aje\/kwag219","relation":{},"ISSN":["0002-9262","1476-6256"],"issn-type":[{"value":"0002-9262","type":"print"},{"value":"1476-6256","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"kwag219"}}