{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:00:48Z","timestamp":1790190048777,"version":"4.1.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["3U54 EB027690-03S1"],"award-info":[{"award-number":["3U54 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":["3U54 EB027690-03S2"],"award-info":[{"award-number":["3U54 EB027690-03S2"]}],"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":["3U54 EB027690-04S1"],"award-info":[{"award-number":["3U54 EB027690-04S1"]}],"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":["75N92022D00015"],"award-info":[{"award-number":["75N92022D00015"]}],"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":["75N92023F00001"],"award-info":[{"award-number":["75N92023F00001"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We previously reported that nasal SARS-CoV-2 viral loads (VLs) peaked around the fourth day of symptoms in highly immune adults sampled April 2022 to April 2023, while influenza A VLs peaked soon after symptom onset. We hypothesized that SARS-CoV-2 kinetics may have changed due to reduced COVID-19 incidence and altered vaccination patterns. Understanding how viral kinetics evolve over time is essential to inform testing strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants with symptomatic upper respiratory infection were recruited at testing centers in Georgia 14 April 2023 to 11 April 2025. Participants reported date of symptom onset and vaccination history. A nasal swab was tested on the Xpert Xpress CoV-2\/Flu\/RSV-Plus assay and cycle threshold (Ct) values recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>552 adults (aged \u226516 years) and 60 children (aged &amp;lt;16 years) were SARS-CoV-2 positive; lowest median Ct values (highest VL) were observed on the second symptomatic day. Adults vaccinated within 12 months (n = 106) had peak VL on the third day, and those vaccinated \u226512 months prior (n = 334), on the second. In influenza A-positive adults (n = 181) and children (n = 147), median VL peaked on the first symptomatic day, vs the fourth day in 157 influenza B-positive participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In 2023\u20132025, median SARS-CoV-2 VL peaked earlier relative to symptom onset compared to a highly immune 2022\u20132023 cohort. More recent vaccination correlated with delayed peak VL, suggesting that more robust immunity correlates with earlier symptom onset relative to peak. Median influenza A VLs were highest at symptom onset, vs 4 days into symptoms for influenza B. These findings can inform use of multiplexed antigen tests amidst changing immunity and viral circulation patterns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiag169","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T12:48:35Z","timestamp":1774529315000},"page":"e506-e514","source":"Crossref","is-referenced-by-count":1,"title":["Peak Nasal SARS-CoV-2 and Influenza Viral Loads Relative to Symptom Onset, 2022\u20132025: Impact of Vaccination and Implications for Multiplexed Testing"],"prefix":"10.1093","volume":"234","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6230-841X","authenticated-orcid":false,"given":"Joanne H","family":"Hunt","sequence":"first","affiliation":[{"name":"Rollins School of Public Health, Department of Epidemiology, Emory University , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2237-1713","authenticated-orcid":false,"given":"Gregory L","family":"Damhorst","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University , Atlanta, Georgia"},{"name":"Atlanta Center for Microsystems Engineered Point-of-Care Technologies , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Parsons","sequence":"additional","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4634-0591","authenticated-orcid":false,"given":"Jennifer K","family":"Frediani","sequence":"additional","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6040-1346","authenticated-orcid":false,"given":"Kaleb B","family":"McLendon","sequence":"additional","affiliation":[{"name":"Emory\/Children's Laboratory for Innovative Assay Development, Department of Pathology, Emory University , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5681-747X","authenticated-orcid":false,"given":"Julie","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Atlanta Center for Microsystems Engineered Point-of-Care Technologies , Atlanta, Georgia"},{"name":"Department of Pediatrics, School of Medicine, Emory University , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrianna L","family":"Westbrook","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, Emory University , Atlanta, Georgia"},{"name":"Pediatric Biostatistics Core, Department of Pediatrics, Emory University , Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0325-7990","authenticated-orcid":false,"given":"Wilbur A","family":"Lam","sequence":"additional","affiliation":[{"name":"Atlanta Center for Microsystems Engineered Point-of-Care Technologies , Atlanta, Georgia"},{"name":"Department of Pediatrics, School of Medicine, Emory University , Atlanta, Georgia"},{"name":"Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta , Atlanta, Georgia"},{"name":"Wallace H. 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