{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:53:42Z","timestamp":1791395622650,"version":"4.3.3"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T00:00:00Z","timestamp":1695859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U54 EB027690 02S1"],"award-info":[{"award-number":["U54 EB027690 02S1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U54 EB027690 03S1"],"award-info":[{"award-number":["U54 EB027690 03S1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U54EB027690 03S2"],"award-info":[{"award-number":["U54EB027690 03S2"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR002378"],"award-info":[{"award-number":["UL1TR002378"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early in the coronavirus disease 2019 (COVID-19) pandemic, peak viral loads coincided with symptom onset. We hypothesized that in a highly immune population, symptom onset might occur earlier in infection, coinciding with lower viral loads.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A viral loads relative to symptom duration in symptomatic adults (\u226516 years) presenting for testing in Georgia (4\/2022\u20134\/2023; Omicron variant predominant). Participants provided symptom duration and recent testing history. Nasal swabs were tested by Xpert Xpress SARS-CoV-2\/Flu\/RSV assay and cycle threshold (Ct) values recorded. Nucleoprotein concentrations in SARS-CoV-2 polymerase chain reaction (PCR)-positive samples were measured by single molecule array. To estimate hypothetical antigen rapid diagnostic test (Ag RDT) sensitivity on each day after symptom onset, percentages of individuals with Ct value \u226430 or \u226425 were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 348 newly-diagnosed SARS-CoV-2 PCR-positive individuals (65.5% women, median 39.2 years), 317\/348 (91.1%) had a history of vaccination, natural infection, or both. By both Ct value and antigen concentration measurements, median viral loads rose from the day of symptom onset and peaked on the fourth\/fifth day. Ag RDT sensitivity estimates were 30.0%\u201360.0% on the first day, 59.2%\u201374.8% on the third day, and 80.0%\u201393.3% on the fourth day of symptoms.<\/jats:p>\n                    <jats:p>In 74 influenza A PCR-positive individuals (55.4% women; median 35.0 years), median influenza viral loads peaked on the second day of symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a highly immune adult population, median SARS-CoV-2 viral loads peaked around the fourth day of symptoms. Influenza A viral loads peaked soon after symptom onset. These findings have implications for ongoing use of Ag RDTs for COVID-19 and influenza.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciad582","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T00:08:07Z","timestamp":1695686887000},"page":"301-307","source":"Crossref","is-referenced-by-count":46,"title":["The New Normal: Delayed Peak SARS-CoV-2 Viral Loads Relative to Symptom Onset and Implications for COVID-19 Testing Programs"],"prefix":"10.1093","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4634-0591","authenticated-orcid":false,"given":"Jennifer K","family":"Frediani","sequence":"first","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Parsons","sequence":"additional","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleb B","family":"McLendon","sequence":"additional","affiliation":[{"name":"Emory\/Children's Laboratory for Innovative Assay Development, Department of Pathology, Emory University , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrianna L","family":"Westbrook","sequence":"additional","affiliation":[{"name":"Pediatric Biostatistics Core, Department of Pediatrics, Emory University , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilbur","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia , USA"},{"name":"Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta , Atlanta, Georgia , USA"},{"name":"Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nira R","family":"Pollock","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Boston Children's Hospital , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,9,28]]},"reference":[{"key":"2024021719321925300_ciad582-B1","doi-asserted-by":"crossref","first-page":"2001483","DOI":"10.2807\/1560-7917.ES.2020.25.32.2001483","article-title":"Duration of infectiousness and correlation with RT-PCR cycle threshold values in cases of COVID-19, England, January to May 2020","volume":"25","author":"Singanayagam","year":"2020","journal-title":"Euro Surveill"},{"key":"2024021719321925300_ciad582-B2","doi-asserted-by":"crossref","first-page":"ofab003","DOI":"10.1093\/ofid\/ofab003","article-title":"Pretest symptom duration and cycle threshold values for severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction predict coronavirus disease 2019 mortality","volume":"8","author":"Miller","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2024021719321925300_ciad582-B3","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1038\/s41591-020-0869-5","article-title":"Temporal dynamics in viral shedding and transmissibility of COVID-19","volume":"26","author":"He","year":"2020","journal-title":"Nat Med"},{"key":"2024021719321925300_ciad582-B4","doi-asserted-by":"crossref","first-page":"e2142796","DOI":"10.1001\/jamanetworkopen.2021.42796","article-title":"Trajectory of viral RNA load among persons with incident SARS-CoV-2 G614 infection (Wuhan strain) in association with COVID-19 symptom onset and severity","volume":"5","author":"Stankiewicz Karita","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2024021719321925300_ciad582-B5","doi-asserted-by":"crossref","first-page":"ofab110","DOI":"10.1093\/ofid\/ofab110","article-title":"Considerations for assessment and deployment of rapid antigen tests for diagnosis of COVID-19","volume":"8","author":"Pollock","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2024021719321925300_ciad582-B6","doi-asserted-by":"publisher","first-page":"ciad032","DOI":"10.1093\/cid\/ciab048","article-title":"Infectious Diseases Society of America guidelines on the diagnosis of COVID-19: antigen testing","author":"Hanson","year":"2021","journal-title":"Infect Dis Soc"},{"key":"2024021719321925300_ciad582-B7","doi-asserted-by":"crossref","first-page":"e0247921","DOI":"10.1128\/jcm.02479-21","article-title":"Assessment of the analytical sensitivity of 10 lateral flow devices against the SARS-CoV-2 Omicron variant","volume":"60","author":"Deerain","year":"2022","journal-title":"J Clin Microbiol"},{"key":"2024021719321925300_ciad582-B8","doi-asserted-by":"crossref","first-page":"e0013922","DOI":"10.1128\/jcm.00139-22","article-title":"The SARS-CoV-2 Omicron variant does not have higher nasal viral loads compared to the Delta variant in symptomatic and asymptomatic individuals","volume":"60","author":"Laitman","year":"2022","journal-title":"J Clin Microbiol"},{"key":"2024021719321925300_ciad582-B9","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1093\/jpids\/piac130","article-title":"Similar SARS-CoV-2 Ct value distributions in anterior nares versus nasopharyngeal samples from symptomatic children during Delta and Omicron surges","volume":"12","author":"Rattan","year":"2023","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2024021719321925300_ciad582-B10","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.7326\/M22-0760","article-title":"Comparison of rapid antigen tests\u2019 performance between Delta and Omicron variants of SARS-CoV-2: a secondary analysis from a serial home self-testing study","volume":"175","author":"Soni","year":"2022","journal-title":"Ann Intern Med"},{"key":"2024021719321925300_ciad582-B11","author":"Soni"},{"key":"2024021719321925300_ciad582-B12","author":"Food and Drug Administration","year":"2022"},{"key":"2024021719321925300_ciad582-B13","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-24277-4","volume-title":"ggplot2: elegant graphics for data analysis","author":"Wickham","year":"2016"},{"key":"2024021719321925300_ciad582-B14","author":"Wickham","year":"2022"},{"key":"2024021719321925300_ciad582-B15","author":"Zhang","year":"2022"},{"key":"2024021719321925300_ciad582-B16","doi-asserted-by":"crossref","first-page":"e0013823","DOI":"10.1128\/jcm.00138-23","article-title":"Sensitivity of rapid antigen tests against SARS-CoV-2 Omicron and Delta variants varies by RT-PCR versus quantitative antigen levels","author":"Rao","year":"2023","journal-title":"J Clin Microbiol"},{"key":"2024021719321925300_ciad582-B17","doi-asserted-by":"crossref","first-page":"e0247918","DOI":"10.1371\/journal.pone.0247918","article-title":"The Abbott PanBio WHO emergency use listed, rapid, antigen-detecting point-of-care diagnostic test for SARS-CoV-2-evaluation of the accuracy and ease-of-use","volume":"16","author":"Kruger","year":"2021","journal-title":"PLoS One"},{"key":"2024021719321925300_ciad582-B18","doi-asserted-by":"crossref","first-page":"e00083-21","DOI":"10.1128\/JCM.00083-21","article-title":"Performance and implementation evaluation of the Abbott BinaxNOW rapid antigen test in a high-throughput drive-through community testing site in Massachusetts","volume":"59","author":"Pollock","year":"2021","journal-title":"J Clin Microbiol"},{"key":"2024021719321925300_ciad582-B19","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.3201\/eid2705.204688","article-title":"Clinical evaluation of Roche SD biosensor rapid antigen test for SARS-CoV-2 in municipal health service testing site, the Netherlands","volume":"27","author":"Igloi","year":"2021","journal-title":"Emerg Infect Dis"},{"key":"2024021719321925300_ciad582-B20","doi-asserted-by":"crossref","first-page":"e3098","DOI":"10.1093\/cid\/ciaa1890","article-title":"Field performance and public health response using the BinaxNOWTM rapid severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen detection assay during community-based testing","volume":"73","author":"Pilarowski","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2024021719321925300_ciad582-B21","doi-asserted-by":"crossref","first-page":"e03077-20","DOI":"10.1128\/JCM.03077-20","article-title":"Correlation of SARS-CoV-2 nucleocapsid antigen and RNA concentrations in nasopharyngeal samples from children and adults using an ultrasensitive and quantitative antigen assay","volume":"59","author":"Pollock","year":"2021","journal-title":"J Clin Microbiol"},{"key":"2024021719321925300_ciad582-B22","doi-asserted-by":"crossref","first-page":"e81849","DOI":"10.7554\/eLife.81849","article-title":"Quantifying the impact of immune history and variant on SARS-CoV-2 viral kinetics and infection rebound: a retrospective cohort study","volume":"11","author":"Hay","year":"2022","journal-title":"Elife"},{"key":"2024021719321925300_ciad582-B23","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.jinf.2022.10.027","article-title":"Viral dynamics of the SARS-CoV-2 Omicron variant among household contacts with 2 or 3 COVID-19 vaccine doses","volume":"85","author":"Kandel","year":"2022","journal-title":"J Infect"},{"key":"2024021719321925300_ciad582-B24","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1001\/jamainternmed.2022.1827","article-title":"Comparison of home antigen testing with RT-PCR and viral culture during the course of SARS-CoV-2 infection","volume":"182","author":"Chu","year":"2022","journal-title":"JAMA Intern Med"},{"key":"2024021719321925300_ciad582-B25","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.cmi.2022.07.010","article-title":"Sars-Cov-2 antigen tests predict infectivity based on viral culture: comparison of antigen, PCR viral load, and viral culture testing on a large sample cohort","volume":"29","author":"Kirby","year":"2023","journal-title":"Clin Microbiol Infect"},{"key":"2024021719321925300_ciad582-B26","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.15585\/mmwr.mm7136a3","article-title":"Detection of higher cycle threshold values in culturable SARS-CoV-2 Omicron BA.1 sublineage compared with pre-Omicron variant specimens\u2014San Francisco Bay Area, California, July 2021-March 2022","volume":"71","author":"Tassetto","year":"2022","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2024021719321925300_ciad582-B27","author":"The White House"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciad582\/52630408\/ciad582.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/78\/2\/301\/56697833\/ciad582.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/78\/2\/301\/56697833\/ciad582.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T14:32:57Z","timestamp":1708180377000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/78\/2\/301\/7285011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,28]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,9,28]]},"published-print":{"date-parts":[[2024,2,17]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciad582","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2023.05.09.23289735","asserted-by":"object"}]},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,2,15]]},"published":{"date-parts":[[2023,9,28]]}}}