The Journal of infectious diseases · 2026
Peak Nasal SARS-CoV-2 and Influenza Viral Loads Relative to Symptom Onset, 2022-2025: Impact of Vaccination and Implications for Multiplexed Testing.
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Hunt Joanne H, Damhorst Gregory L, Parsons Richard, Frediani Jennifer K, McLendon Kaleb B, Sullivan Julie, Westbrook Adrianna L, Lam Wilbur A, Martin Greg S, Pollock Nira R
Аннотация
BACKGROUND: 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.
METHODS: 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.
RESULTS: 552 adults (aged ≥16 years) and 60 children (aged <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 ≥12 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.
CONCLUSIONS: In 2023-2025, median SARS-CoV-2 VL peaked earlier relative to symptom onset compared to a highly immune 2022-2023 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.
METHODS: 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.
RESULTS: 552 adults (aged ≥16 years) and 60 children (aged <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 ≥12 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.
CONCLUSIONS: In 2023-2025, median SARS-CoV-2 VL peaked earlier relative to symptom onset compared to a highly immune 2022-2023 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.