Hannah E Segaloff’s research while affiliated with Centers for Disease Control and Prevention and other places

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Publications (43)


Post-COVID Condition Risk Factors and Symptom Clusters and Associations with Return to Pre-COVID Health-Results from a 2021 Multi-State Survey
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December 2024

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14 Reads

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1 Citation

Clinical Infectious Diseases

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Reed Magleby

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Robert A Bonacci

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Background: Little is known about how symptoms or symptom clusters of Post-COVID Conditions (PCC) impact an individual's return to pre-COVID health. Methods: We used four state-level COVID-19 case reporting systems and patient-reported survey data to identify patients with PCC and associations with an individual's return to pre-COVID health after laboratory-confirmed SARS-CoV-2 infection. Participants had a positive SARS-CoV-2 test between March-December 2020. Weighted regression models were used to 1) estimate prevalence of PCC; 2) identify risk factors associated with developing PCC; and 3) examine associations between PCC symptom clusters and return to pre-COVID health. Factor analysis was used to statistically identify post-COVID symptom clusters. Findings: Prevalence of PCC in this population-based sample was 29·9% for persons with SARS-CoV-2 infection, during the pre-delta variant period (March-December 2020); 77·2% of persons experiencing PCC had not returned to pre-COVID health within 8-60 weeks after infection. Female sex, acute COVID-19 illness severity, and number of pre-existing comorbidities were significant risk factors associated with PCC. Myalgic encephalomyelitis/chronic fatigue syndrome-like symptoms, upper-respiratory symptoms, and gastrointestinal symptoms were significantly associated with not returning to pre-COVID health. Interpretation: Understanding PCC symptom clustering may provide insight into pathophysiology, severity of PCC, and management for patients who have not returned to their usual state of health after SARS-CoV-2 infection. Tracking PCC can help measure the impact of COVID-19 vaccination and acute COVID-19-specific treatments on reducing PCC in the US.


Human and Canine Blastomycosis Cases Associated with Riverside Neighborhood, Wisconsin, USA, December 2021-March 20221

December 2024

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2 Reads

Emerging Infectious Diseases

We investigated a blastomycosis cluster among humans and canines in a neighborhood in Wisconsin, United States. We conducted interviews and collected serum specimens for Blastomyces antibody testing by enzyme immunoassay. Although no definitive exposure was identified, evidence supports potential exposures from the riverbank, riverside trails or yards, or construction dust.


Proportionate morbidity ratios (PMRs) and 99% confidence intervals (CIs) by occupation group in a sample of employed mpox cases among men from seven U.S. jurisdictions, May 2022–March 2023.
Proportionate morbidity ratios (PMRs) and 99% confidence intervals (CIs) by industry sector in a sample of employed mpox cases among men from seven U.S. jurisdictions, May 2022–March 2023.
Analysis of Mpox by Occupation and Industry in Seven U.S. Jurisdictions, May 2022–March 2023
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  • Full-text available

October 2024

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24 Reads

During responses to outbreaks, the collection and analysis of data on employed case patients’ industry and occupation are necessary to better understand the relationship between work and health outcomes. The occurrence of mpox by occupation and industry has not previously been assessed in the context of the 2022 outbreak. We analyzed employment data from 2548 mpox cases reported to the U.S. Centers for Disease Control and Prevention from surveillance systems in seven U.S. jurisdictions and population-based reference data on employment patterns from the U.S. Bureau of Labor Statistics to describe the differential proportionate distribution of cases across occupation and industry groups using the proportionate morbidity ratio. In gender-specific analyses, we found that men employed in certain occupations and industries had a higher relative risk of mpox than others. While occupational transmission cannot be ruled out, it is more likely that individuals with personal and behavioral risk factors for mpox were more likely to work in these occupations and industries. This analysis provides an example of collecting and analyzing occupation and industry data in case reports to understand possible differences in risk by occupation and industry in infectious disease outbreak investigation and help inform resource allocation, messaging, and response.

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SARS-CoV-2 outbreak among staff and evacuees at Operation Allies Welcome Safe Havens

July 2023

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27 Reads

We report on five SARS-CoV-2 congregate setting outbreaks at U.S. Operation Allies Welcome Safe Havens/military facilities. Outbreak data were collected, and attack rates were calculated for various populations. Even in vaccinated populations, there was rapid spread, illustrating the importance of institutional prevention and mitigation policies in congregate settings.


Distribution of anti-SARS-CoV-2 IgG antibody levels from sera samples (N = 333) collected from a sample of university students (N = 306) who had only completed a primary series of a COVID-19 vaccine or were unvaccinated — fall academic semester 2021, Wisconsin. Top row, A: antibody levels targeting the spike protein of SARS-CoV-2 (anti-S). Bottom row, B: antibody levels targeting the nucleocapsid of SARS-CoV-2 (anti-N). Within each row, on the left, a scatterplot—shaded according to previous COVID-19 status—and overlaid boxplot displays antibody levels in WHO-standardized binding antibody units per milliliter (BAU/mL), log(10) scale. On the right, notched boxplots are presented, reflecting the 95% confidence intervals around the median value; these only reflect data from students without previous COVID-19. Total datapoints per category are included above each vaccine group. Horizontal dashed lines indicate the assay threshold of positivity. One student (with receipt of Covaxin primary series) not presented
Distribution of anti-SARS-CoV-2 IgG antibody levels from sera samples (N = 51) collected from a sample of university students (N = 49) with receipt of an mRNA COVID-19 vaccine booster dose — fall academic semester 2021, Wisconsin. Top row, A: antibody levels targeting the spike protein of SARS-CoV-2 (anti-S). Bottom row, B: antibody levels targeting the nucleocapsid of SARS-CoV-2 (anti-N). Within each row, on the left, a scatterplot—shaded according to previous COVID-19 status—and overlaid boxplot displays antibody levels in WHO-standardized binding antibody units per milliliter (BAU/mL), log(10) scale. On the right, notched boxplots are presented, reflecting the 95% confidence intervals around the median value; these only reflect data from students without previous COVID-19. Total datapoints per category are included above each vaccine group. Horizontal dashed lines indicate the assay threshold of positivity. One student (with receipt of Covaxin primary, J&J/Janssen booster) not presented
Stratified boxplots representing the distribution of anti-spike antibody levels detected in 393 sera specimen classified by immunization history of student at time of blood draw — fall academic semester 2021, Wisconsin. Boxplots reflect antibody levels targeting the spike protein of SARS-CoV-2 (anti-S) in WHO-standardized binding antibody units per milliliter (BAU/mL), log (10) scale. Notched boxplots are presented, where the width of the notch indicates the 95% CIs around the median value. Horizontal dashed lines indicate the assay threshold of positivity
Anti-S IgG antibody levels and multivariate mixed-effects regression model estimates among university students with no history of COVID-19 or immunocompromised status, faceted by booster dose receipt — fall academic semester 2021, Wisconsin. Panels display levels of antibody targeting the spike protein of SARS-CoV-2 (anti-S), in WHO-standardized binding antibody units per milliliter (BAU/mL), log (10) scale. Sex-adjusted, mixed-effects linear regression estimates are superimposed on top of scatter plots with shading reflecting the 95% confidence intervals to estimate anti-S decline associated with primary series vaccine type (e.g., mRNA vs inactivated whole virus, or IWV). Panel A displays anti-S values of students with receipt of COVID-19 vaccine primary series across months since completion of primary series. Panel B displays anti-S values of students who received an mRNA booster dose across months since receipt of booster dose. Data outliers that were not included in the model based on Cook’s Distance are denoted as a boxed point and were not used to calculate adjusted regression lines
Paired sera results for students who participated during the investigation’s September and December time points — fall academic semester 2021, Wisconsin. Top panel displays the levels of antibody targeting the spike protein of SARS-CoV-2 (anti-S) and the bottom panel displays the levels of antibody targeting the nucleocapsid protein (anti-N), both in WHO-standardized binding antibody units per milliliter (BAU/mL), log (10) scale. Month of blood draw is presented on the x-axis. Sera values are categorized based on previous history of COVID-19 illness (shape) and vaccination status (color) at blood draw. Horizontal dashed lines indicate the assay threshold of positivity
Assessment of Anti-SARS-CoV-2 antibody levels among university students vaccinated with different COVID-19 primary and booster doses — fall 2021, Wisconsin

June 2023

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77 Reads

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5 Citations

BMC Infectious Diseases

Background University students commonly received COVID-19 vaccinations before returning to U.S. campuses in the Fall of 2021. Given likely immunologic variation among students based on differences in type of primary series and/or booster dose vaccine received, we conducted serologic investigations in September and December 2021 on a large university campus in Wisconsin to assess anti-SARS-CoV-2 antibody levels. Methods We collected blood samples, demographic information, and COVID-19 illness and vaccination history from a convenience sample of students. Sera were analyzed for both anti-spike (anti-S) and anti-nucleocapsid (anti-N) antibody levels using World Health Organization standardized binding antibody units per milliliter (BAU/mL). Levels were compared across categorical primary COVID-19 vaccine series received and binary COVID-19 mRNA booster status. The association between anti-S levels and time since most recent vaccination dose was estimated by mixed-effects linear regression. Results In total, 356 students participated, of whom 219 (61.5%) had received a primary vaccine series of Pfizer-BioNTech or Moderna mRNA vaccines and 85 (23.9%) had received vaccines from Sinovac or Sinopharm. Median anti-S levels were significantly higher for mRNA primary vaccine series recipients (2.90 and 2.86 log [BAU/mL], respectively), compared with those who received Sinopharm or Sinovac vaccines (1.63 and 1.95 log [BAU/mL], respectively). Sinopharm and Sinovac vaccine recipients were associated with a significantly faster anti-S decline over time, compared with mRNA vaccine recipients ( P <.001). By December, 48/172 (27.9%) participants reported receiving an mRNA COVID-19 vaccine booster, which reduced the anti-S antibody discrepancies between primary series vaccine types. Conclusions Our work supports the benefit of heterologous boosting against COVID-19. COVID-19 mRNA vaccine booster doses were associated with increases in anti-SARS-CoV-2 antibody levels; following an mRNA booster dose, students with both mRNA and non-mRNA primary series receipt were associated with comparable levels of anti-S IgG.



Clustering metrics for the 2017/2018 influenza season, including the silhouette plot of k‐medoids clusters (A) and the top two principal components of data in the k‐medoids clustering algorithm (B), with cluster membership highlighted.
Adjusted odds ratios (A,C) and difference in model‐adjusted means (B,D) with 95% confidence intervals for outcomes. * indicates statistically significant differences between comparison groups. Models were adjusted for age, sex, hospital, continuous CCI, and influenza vaccination status.
Clustering metrics for the 2018/2019 influenza season, including the silhouette plot of k‐medoids clusters (A) and the top two principal components of data in the k‐medoids clustering algorithm (B), with cluster membership highlighted.
K‐medoids clustering of hospital admission characteristics to classify severity of influenza virus infection

March 2023

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32 Reads

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4 Citations

Background: Patients are admitted to the hospital for respiratory illness at different stages of their disease course. It is important to appropriately analyse this heterogeneity in surveillance data to accurately measure disease severity among those hospitalized. The purpose of this study was to determine if unique baseline clusters of influenza patients exist and to examine the association between cluster membership and in-hospital outcomes. Methods: Patients hospitalized with influenza at two hospitals in Southeast Michigan during the 2017/2018 (n = 242) and 2018/2019 (n = 115) influenza seasons were included. Physiologic and laboratory variables were collected for the first 24 h of the hospital stay. K-medoids clustering was used to determine groups of individuals based on these values. Multivariable linear regression or Firth's logistic regression were used to examine the association between cluster membership and clinical outcomes. Results: Three clusters were selected for 2017/2018, mainly differentiated by blood glucose level. After adjustment, those in C171 had 5.6 times the odds of mechanical ventilator use than those in C172 (95% CI: 1.49, 21.1) and a significantly longer mean hospital length of stay than those in both C172 (mean 1.5 days longer, 95% CI: 0.2, 2.7) and C173 (mean 1.4 days longer, 95% CI: 0.3, 2.5). Similar results were seen between the two clusters selected for 2018/2019. Conclusion: In this study of hospitalized influenza patients, we show that distinct clusters with higher disease acuity can be identified and could be targeted for evaluations of vaccine and influenza antiviral effectiveness against disease attenuation. The association of higher disease acuity with glucose level merits evaluation.


Comparing the Etiology of Viral Acute Respiratory Illnesses Between Children Who Do and Do Not Attend Childcare

February 2023

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11 Reads

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3 Citations

The Pediatric Infectious Disease Journal

Background and objective: Childcare attendance is a common risk factor for acute respiratory illness (ARI) in young children. Our goal was to better understand the specific respiratory viruses that predominate in childcare, which may support the development of tailored illness prevention and intervention strategies in childcare settings. Methods: Using data from a prospective household cohort of ARI surveillance, we assessed specimen from 1418 ARIs reported by 359 childcare-aged children over 6 study seasons (2012/2013 through 2017/2018). Respiratory swabs were tested by polymerase chain reaction for 9 respiratory viruses. A mixed-effect logistic regression model was used to compare odds of various viral detection outcomes. The Shannon's Diversity index was used to compare the richness (ie, number of species) and diversity (ie, relative species abundance) associated with respiratory viruses detected in both groups. Results: At least 1 virus was detected in 75.5% of childcare-associated ARIs and in 80.1% of homecare ARIs. Compared with illnesses among homecare children, childcare illnesses were associated with significantly higher odds of detected adenovirus (odds ratio = 1.86, 95% confidence interval = 1.05-3.28) and human metapneumovirus (odds ratio = 1.76, 95% confidence interval = 1.03-3.0). The pool of viruses associated with childcare ARI was found to be significantly richer and more diverse than that of viruses associated with homecare ARI (P < 0.0001). Conclusions: Children attending childcare experience a higher risk of adenovirus and human metapneumovirus infection and are regularly exposed to a rich and diverse pool of respiratory viruses in childcare environments. Our results underscore the necessity of thorough and multifaceted viral prevention strategies in childcare settings.


K-medoids clustering of hospital admission characteristics to classify severity of influenza virus infection

December 2022

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8 Reads

Background: Patients are admitted to the hospital for respiratory illness at different stages of their disease course. It is important to appropriately analyse this heterogeneity in surveillance data to accurately measure disease severity among those hospitalized. The purpose of this study was to determine if unique baseline clusters of influenza patients exist, and to examine the association between cluster membership and in-hospital outcomes. Methods: Patients hospitalized with influenza at two hospitals in Southeast Michigan during the 2017/2018 (n=242) and 2018/2019 (n=115) influenza seasons were included. Physiologic and laboratory variables were collected for the first 24 hours of the hospital stay. K-medoids clustering was used to determine groups of individuals based on these values. Multivariable linear regression or Firth’s logistic regression were used to examine the association between cluster membership and clinical outcomes. Results: Three clusters were selected for 2017/2018, mainly differentiated by blood glucose level. After adjustment, those in C171 had 5.6 times the odds of mechanical ventilator use than those in C172 (95%CI: 1.49,21.1) and a significantly longer mean hospital length of stay than those in both C172 (mean 1.5 days longer, 95%CI: 0.2,2.7) and C173 (mean 1.4 days longer, 95%CI: 0.3,2.5). Similar results were seen between the two clusters selected for 2018/2019. Conclusion: In this study of hospitalized influenza patients, we show that distinct clusters with higher disease acuity can be identified and could be targeted for evaluations of vaccine and influenza antiviral effectiveness against disease attenuation. The association of higher disease acuity with glucose level merits evaluation.


Individuals infected with SARS-CoV-2 despite full vaccination have low Ct values and shed similar amounts of infectious virus as unvaccinated individuals
A. N1 Ct values for SARS-CoV-2-positive specimens were grouped by vaccination status. RT-PCR was performed by Exact Sciences Corporation, responsible for over 10% of all PCR tests in Wisconsin during this period, using a qualitative diagnostic assay targeting the SARS-CoV-2 N gene (oligonucleotides identical to CDC’s N1 primer and probe set) that has been authorized for emergency use by FDA (https://www.fda.gov/media/138328/download)). See also Table 1. An effect size of d< 0.2 is negligible. The number of samples in each group is listed under the dot plot. B. N1 Ct values for SARS-CoV-2-positive specimens grouped by vaccination status for individuals who were symptomatic or either asymptomatic or did not have any information, at the time of testing. Light yellow box indicates Ct values <25. C. We performed plaque assays on Vero E6 TMPRSS2 cells on a subset of specimens. Specimens were selected by N1 Ct-matching between fully vaccinated and unvaccinated persons. Specimens from individuals with unknown vaccination status were excluded from the analysis. Infectious titers are expressed as plaque-forming units (PFU) per milliliter of specimen. Specimens underwent a freeze-thaw cycle prior to virus titration.
Vaccinated vs. Unvaccinated
Shedding of infectious SARS-CoV-2 despite vaccination

September 2022

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269 Reads

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77 Citations

The SARS-CoV-2 Delta Variant of Concern is highly transmissible and contains mutations that confer partial immune escape. The emergence of Delta in North America caused the first surge in COVID-19 cases after SARS-CoV-2 vaccines became widely available. To determine whether individuals infected despite vaccination might be capable of transmitting SARS-CoV-2, we compared RT-PCR cycle threshold (Ct) data from 20,431 test-positive anterior nasal swab specimens from fully vaccinated (n = 9,347) or unvaccinated (n = 11,084) individuals tested at a single commercial laboratory during the interval 28 June– 1 December 2021 when Delta variants were predominant. We observed no significant effect of vaccine status alone on Ct value, nor when controlling for vaccine product or sex. Testing a subset of low-Ct (<25) samples, we detected infectious virus at similar rates, and at similar titers, in specimens from vaccinated and unvaccinated individuals. These data indicate that vaccinated individuals infected with Delta variants are capable of shedding infectious SARS-CoV-2 and could play a role in spreading COVID-19.


Citations (30)


... Using multivariable logistic regression analyses, we estimated the odds of having !1 COVID-like symptom lasting >4 weeks following a positive SARS-CoV-2 test and their duration: 1) among individuals who reported testing positive for SARS-CoV-2, comparing adults with and without disabilities; 2) among adults with disabilities, comparing those with a positive test to those with a negative test; and 3) among adults without disabilities, comparing those with a positive test to those with a negative test. We described symptom clusters observed >4 weeks after infection in these respondents that were associated with not returning to pre-COVID physical and mental health in another survey of U.S. adults from this time period (see Appendix B). 25 (Certain analyses did not compare respondents with and without disabilities due to small sample size of subgroups.) All odds ratios in the multivariable logistic regression model were adjusted for categorical age, sex, race/ethnicity, highest level of education completed, employment status, and U.S. census region. ...

Reference:

Post-COVID Conditions and Healthcare Utilization Among Adults With and Without Disabilities—2021 Porter Novelli FallStyles Survey
Post-COVID Condition Risk Factors and Symptom Clusters and Associations with Return to Pre-COVID Health-Results from a 2021 Multi-State Survey
  • Citing Article
  • December 2024

Clinical Infectious Diseases

... When we compared the group of individuals who had received a booster dose of the same commercial vaccine to a group of individuals who had received a booster dose of a different commercial vaccine, we found that the mixed vaccine produced higher levels of antibodies. Our results support the conclusion that heterologous vaccination is an immune potentiator and are in agreement with previous reports in academic populations, which also corroborates the effectiveness of heterologous boosting against COVID-19 [68]. Nevertheless, the underlying mechanism for increased immunity when combining COVID-19 vaccines has not been properly established. ...

Assessment of Anti-SARS-CoV-2 antibody levels among university students vaccinated with different COVID-19 primary and booster doses — fall 2021, Wisconsin

BMC Infectious Diseases

... This method identifies medoids (representative data points within each cluster), unlike K-Means which uses centroids-the mean of all data points in a cluster-making it better suited for binary data 25,27 . Furthermore, it is more robust against noise and outliers, 28,29 therefore making it better suited for smaller datasets 24,29,30 . We used the "cluster" library in R statistical software for the analyses 31 . ...

K‐medoids clustering of hospital admission characteristics to classify severity of influenza virus infection

... Nesti and Goldbaum stated that the risk of infection among children at preschool education centers has increased 2-3 times, which is a significant issue in terms of both personal health and community health [4]. Several other studies indicate the prevalence of infectious diseases and the increased risk of infection at preschool education institutions [5][6][7][8][9][10][11][12][13][14][15][16]. They are identified as a risk factor in the spread of infectious diseases; however, the solution to this risk does not involve keeping children away from them. ...

Comparing the Etiology of Viral Acute Respiratory Illnesses Between Children Who Do and Do Not Attend Childcare
  • Citing Article
  • February 2023

The Pediatric Infectious Disease Journal

... Our study showed that the Mean ± SD of Age (years) was 39. 22 Smoking status in N=500 individuals showed that there were 47 smokers in 259 males. Our study shows there is a weak positive correlation between smoking status and the viral load of corona. ...

Shedding of infectious SARS-CoV-2 despite vaccination

... Antimicrobial resistance (AMR) is a significant health threat that arises at the interface between human, animal, and environmental health. 40,64,72 Industrial waste products, as well as waste from humans and animals containing antibiotic residues or antimicrobial-resistant bacteria, are shed into the environment, promoting the development of resistance genes and the dispersal of resistant bacteria. 32,70,78 Resistant bacteria are subsequently transmitted through direct person-to-person, animal-to-animal, animal-to-person, or person-to-animal contact, or via indirect environmental exposures. ...

Behaviors and attitudes of college students during an academic semester at two Wisconsin universities during the COVID-19 pandemic
  • Citing Article
  • July 2022

... The literature describing medical responses during OAW is currently limited to military efforts that occurred in and around the domestic military bases called Safe Havens (4)(5)(6)(7)(8)(9). Most evacuees initially spent 1-6 months at one of eight Safe Havens where they received basic medical care and vaccines prior to resettling across the U.S. (4). ...

Public Health Actions to Control Measles Among Afghan Evacuees During Operation Allies Welcome - United States, September-November 2021

MMWR. Morbidity and mortality weekly report

... Considering that pre-immunization SARS-CoV-2 IgG antibody levels quantified in academic environments were relatively low [44] and that the higher percentages of seropositive students were reported at the end of the semester [45], in order to ensure the safe reopening of educational institutions, research aiming at SARS-CoV-2 seroprevalence among students, professors, and staff members was crucial. Here, we performed a semiquantitative binding assay to retrospectively measure IgG against SARS-CoV-2 Spike protein to evaluate the magnitude of antibody responses in the academic community of IPL resultant from different vaccination schemes available at the time of sample collection. ...

A cohort study measuring SARS-CoV-2 seroconversion and serial viral testing in university students

BMC Infectious Diseases

... Year-round acute respiratory illness (ARI) surveillance began in 2015. [10][11][12][13] The study conducted active surveillance for ARIs among cohort enrollees during the COVID-19 pandemic once new strategies to collect specimens were implemented according to SARS-CoV-2 transmissioncontrol restrictions. 14 Here, we report changes to the circulation of respiratory viruses throughout multiple early waves of the pandemic in a cohort of households reporting high levels of COVID-19 mitigation practices with repeated serosurveys for the acquisition of SARS-CoV-2 antibodies. ...

Distinct influenza surveillance networks and their agreement in recording regional influenza circulation: Experience from Southeast Michigan