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Er JC. Improving Influenza Nomenclature Based on Transmission Dynamics. Viruses 2025; 17:633. [PMID: 40431645 PMCID: PMC12115919 DOI: 10.3390/v17050633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Revised: 04/22/2025] [Accepted: 04/24/2025] [Indexed: 05/29/2025] Open
Abstract
Influenza A viruses (IAVs) evolve rapidly, exhibit zoonotic potential, and frequently adapt to new hosts, often establishing long-term reservoirs. Despite advancements in genetic sequencing and phylogenetic classification, current influenza nomenclature systems remain static, failing to capture evolving epidemiological patterns. This rigidity has led to delays or misinterpretations in public health responses, economic disruptions, and confusion in scientific communication. The existing nomenclature does not adequately reflect real-time transmission dynamics or host adaptations, limiting its usefulness for public health management. The 2009 H1N1 pandemic exemplified these limitations, as it was mischaracterized as "swine flu" despite sustained human-to-human transmission and no direct pig-to-human transmission reported. This review proposes a real-time, transmission-informed nomenclature system that prioritizes host adaptation and sustained transmissibility (R0 > 1) to align influenza classification with epidemiological realities and risk management. Through case studies of H1N1pdm09, H5N1, and H7N9, alongside a historical overview of influenza naming, we demonstrate the advantages of integrating transmission dynamics into naming conventions. Adopting a real-time, transmission-informed approach will improve pandemic preparedness, strengthen global surveillance, and enhance influenza classification for scientists, policymakers, and public health agencies.
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Hamilton KA, Harrison JC, Mitchell J, Weir M, Verhougstraete M, Haas CN, Nejadhashemi AP, Libarkin J, Aw TG, Bibby K, Bivins A, Brown J, Dean K, Dunbar G, Eisenberg J, Emelko M, Gerrity D, Gurian PL, Hartnett E, Jahne M, Jones RM, Julian TR, Li H, Li Y, Gibson JM, Medema G, Meschke JS, Mraz A, Murphy H, Oryang D, Johnson Owusu-Ansah EDG, Pasek E, Pradhan AK, Pepe Razzolini MT, Ryan MO, Schoen M, Smeets PWMH, Sollera J, Solo-Gabriele H, Williams C, Wilson AM, Zimmer-Faust A, Alja’fari J, Rose JB. Research gaps and priorities for quantitative microbial risk assessment (QMRA). RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024; 44:2521-2536. [PMID: 38772724 PMCID: PMC11560611 DOI: 10.1111/risa.14318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 03/12/2024] [Accepted: 04/28/2024] [Indexed: 05/23/2024]
Abstract
The coronavirus disease 2019 pandemic highlighted the need for more rapid and routine application of modeling approaches such as quantitative microbial risk assessment (QMRA) for protecting public health. QMRA is a transdisciplinary science dedicated to understanding, predicting, and mitigating infectious disease risks. To better equip QMRA researchers to inform policy and public health management, an Advances in Research for QMRA workshop was held to synthesize a path forward for QMRA research. We summarize insights from 41 QMRA researchers and experts to clarify the role of QMRA in risk analysis by (1) identifying key research needs, (2) highlighting emerging applications of QMRA; and (3) describing data needs and key scientific efforts to improve the science of QMRA. Key identified research priorities included using molecular tools in QMRA, advancing dose-response methodology, addressing needed exposure assessments, harmonizing environmental monitoring for QMRA, unifying a divide between disease transmission and QMRA models, calibrating and/or validating QMRA models, modeling co-exposures and mixtures, and standardizing practices for incorporating variability and uncertainty throughout the source-to-outcome continuum. Cross-cutting needs identified were to: develop a community of research and practice, integrate QMRA with other scientific approaches, increase QMRA translation and impacts, build communication strategies, and encourage sustainable funding mechanisms. Ultimately, a vision for advancing the science of QMRA is outlined for informing national to global health assessments, controls, and policies.
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Affiliation(s)
- Kerry A. Hamilton
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, Tempe AZ 85281
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe AZ 85281
| | - Joanna Ciol Harrison
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, Tempe AZ 85281
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe AZ 85281
| | - Jade Mitchell
- Department of Biosystems and Agricultural Engineering, Michigan State University, East Lansing, MI
| | - Mark Weir
- Division of Environmental Health Sciences and Sustainability Institute, The Ohio State University, Columbus, OH 43210
| | - Marc Verhougstraete
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona 85724
| | - Charles N. Haas
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, PA
| | - A. Pouyan Nejadhashemi
- Department of Biosystems and Agricultural Engineering, Michigan State University, East Lansing, MI
| | - Julie Libarkin
- Department of Earth and Environmental Sciences, Michigan State University, East Lansing, MI
| | - Tiong Gim Aw
- Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112
| | - Kyle Bibby
- Department of Civil and Environmental Engineering and Earth Sciences, University of Notre Dame, IN 46556, USA
| | - Aaron Bivins
- Department of Civil & Environmental Engineering, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Kara Dean
- Department of Biosystems and Agricultural Engineering, Michigan State University, East Lansing, MI
| | - Gwyneth Dunbar
- Department of Biosystems and Agricultural Engineering, Michigan State University, East Lansing, MI
| | - Joseph Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor MI 48103, USA
| | - Monica Emelko
- Department of Civil and Environmental Engineering, University of Waterloo, Waterloo, ON N2L 5H1, Canada
| | - Daniel Gerrity
- Applied Research and Development Center, Southern Nevada Water Authority, Las Vegas, NV 89193
| | - Patrick L. Gurian
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, PA
| | | | - Michael Jahne
- Office of Research and Development, United States Environmental Protection Agency, 26 W Martin Luther King Dr, Cincinnati, OH, USA 45268
| | - Rachael M. Jones
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 S Charles E Young Dr. S., Los Angeles CA 90095, USA
| | - Timothy R. Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600 Duebendorf, Switzerland
| | - Hongwan Li
- Department of Biosystems and Agricultural Engineering, Michigan State University, East Lansing, MI
| | - Yanbin Li
- Department of Biological and Agricultural Engineering, The University of Arkansas, Fayetteville, AR 72701
| | - Jacqueline MacDonald Gibson
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC 27695
| | - Gertjan Medema
- KWR Water Research Institute, The Netherlands
- TU Delft, The Netherlands
| | - J. Scott Meschke
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 4225 Roosevelt Way, suite 100, Seattle, WA 98105-6099
| | - Alexis Mraz
- Department of Public Health, School of Nursing, Health and Exercise Science, The College of New Jersey, 2000 Pennington Ave, Ewing, NJ 08618
| | | | - David Oryang
- Center for Food Safety and Applied Nutrition (CFSAN), US Food and Drug Administration (USFDA)
| | | | - Emily Pasek
- Department of Earth and Environmental Sciences, Michigan State University, East Lansing, MI
| | - Abani K. Pradhan
- Department of Nutrition and Food Science & Center for Food Safety and Security Systems, University of Maryland, College Park, MD 20742, USA
| | | | - Michael O. Ryan
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, PA
| | - Mary Schoen
- Soller Environmental, LLC, 3022 King St Berkeley, CA 94703, USA
| | | | - Jeffrey Sollera
- Division of Environmental Health Sciences and Sustainability Institute, The Ohio State University, Columbus, OH 43210
| | - Helena Solo-Gabriele
- Department of Chemical, Environmental, and Materials Engineering, College of Engineering, University of Miami, 1251 Memorial Drive, Coral Gables, FL 33146, USA
| | - Clinton Williams
- US Arid Land Agricultural Research Center, USDA-ARS, 21881 N cardon Ln, Maricopa, AZ 85138, USA
| | - Amanda Marie Wilson
- Community, Environment & Policy Department, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona
| | - Amy Zimmer-Faust
- Southern California Coastal Water Research Project, Costa Mesa, California, USA 92626
| | - Jumana Alja’fari
- National Institute of Standards and Technology (NIST), 100 Bureau Drive, Gaithersburg, MD 20899
| | - Joan B. Rose
- Department of Biosystems and Agricultural Engineering, Michigan State University, East Lansing, MI
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Judson SD, Dowdy DW. Modeling zoonotic and vector-borne viruses. Curr Opin Virol 2024; 67:101428. [PMID: 39047313 PMCID: PMC11292992 DOI: 10.1016/j.coviro.2024.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024]
Abstract
The 2013-2016 Ebola virus disease epidemic and the coronavirus disease 2019 pandemic galvanized tremendous growth in models for emerging zoonotic and vector-borne viruses. Therefore, we have reviewed the main goals and methods of models to guide scientists and decision-makers. The elements of models for emerging viruses vary across spectrums: from understanding the past to forecasting the future, using data across space and time, and using statistical versus mechanistic methods. Hybrid/ensemble models and artificial intelligence offer new opportunities for modeling. Despite this progress, challenges remain in translating models into actionable decisions, particularly in areas at highest risk for viral disease outbreaks. To address this issue, we must identify gaps in models for specific viruses, strengthen validation, and involve policymakers in model development.
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Affiliation(s)
- Seth D Judson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - David W Dowdy
- Division of Infectious Disease Epidemiology, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Data-rich modeling helps answer increasingly complex questions on variant and disease interactions: Comment on "Mathematical models for dengue fever epidemiology: A 10-year systematic review" by Aguiar et al. Phys Life Rev 2023; 44:197-200. [PMID: 36773393 PMCID: PMC9893800 DOI: 10.1016/j.plrev.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
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Li Y, Hsu EB, Pham N, Davis XM, Podgornik MN, Trigoso SM. Developing Public Health Emergency Response Leaders in Incident Management: A Scoping Review of Educational Interventions. Disaster Med Public Health Prep 2022; 16:2149-2178. [PMID: 34462032 DOI: 10.1017/dmp.2021.164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
During emergency responses, public health leaders frequently serve in incident management roles that differ from their routine job functions. Leaders' familiarity with incident management principles and functions can influence response outcomes. Therefore, training and exercises in incident management are often required for public health leaders. To describe existing methods of incident management training and exercises in the literature, we queried 6 English language databases and found 786 relevant articles. Five themes emerged: (1) experiential learning as an established approach to foster engaging and interactive learning environments and optimize training design; (2) technology-aided decision support tools are increasingly common for crisis decision-making; (3) integration of leadership training in the education continuum is needed for developing public health response leaders; (4) equal emphasis on competency and character is needed for developing capable and adaptable leaders; and (5) consistent evaluation methodologies and metrics are needed to assess the effectiveness of educational interventions.These findings offer important strategic and practical considerations for improving the design and delivery of educational interventions to develop public health emergency response leaders. This review and ongoing real-world events could facilitate further exploration of current practices, emerging trends, and challenges for continuous improvements in developing public health emergency response leaders.
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Affiliation(s)
- Yang Li
- CNA, Institute for Public Research (IPR), Arlington, VA, USA
| | - Edbert B Hsu
- Johns Hopkins University, Department of Emergency Medicine, Baltimore, MD, USA
| | - NhuNgoc Pham
- CNA, Institute for Public Research (IPR), Arlington, VA, USA
| | - Xiaohong Mao Davis
- Centers for Disease Control and Prevention (CDC), Center for Preparedness and Response (CPR), Division of Emergency Operations (DEO), Atlanta, GA, USA
| | - Michelle N Podgornik
- Centers for Disease Control and Prevention (CDC), Center for Preparedness and Response (CPR), Division of Emergency Operations (DEO), Atlanta, GA, USA
| | - Silvia M Trigoso
- Centers for Disease Control and Prevention (CDC), Center for Preparedness and Response (CPR), Division of Emergency Operations (DEO), Atlanta, GA, USA
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CHRONIC WASTING DISEASE MODELING: AN OVERVIEW. J Wildl Dis 2021; 56:741-758. [PMID: 32544029 DOI: 10.7589/2019-08-213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/13/2019] [Indexed: 11/20/2022]
Abstract
Chronic wasting disease (CWD) is an infectious and fatal prion disease occurring in the family Cervidae. To update the research community regarding the status quo of CWD epidemic models, we conducted a meta-analysis on CWD research. We collected data from peer-reviewed articles published since 1980, when CWD was first diagnosed, until December 2018. We explored the analytical methods used historically to understand CWD. We used 14 standardized variables to assess overall analytical approaches of CWD research communities, data used, and the modeling methods used. We found that CWD modeling initiated in the early 2000s and has increased since then. Connectivity of the research community was heavily reliant on a cluster of CWD researchers. Studies focused primarily on regression and compartment-based models, population-level approaches, and host species of game management concern. Similarly, CWD research focused on single populations, species, and locations, neglecting modeling using community ecology and biogeographic approaches. Chronic wasting disease detection relied on classic diagnostic methods with limited sensitivity for most stages of infection. Overall, we found that past modeling efforts generated a solid baseline for understanding CWD in wildlife and increased our knowledge on infectious prion ecology. Future analytical efforts should consider more sensitive diagnostic methods to quantify uncertainty and broader scale studies to elucidate CWD transmission beyond population-level approaches. Considering that infectious prions may not follow biological rules of well-known wildlife pathogens (i.e., viruses, bacteria, fungi), assumptions used when modeling other infectious disease may not apply for CWD. Chronic wasting disease is a new challenge in wildlife epidemiology.
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Vardavas R, de Lima PN, Davis PK, Parker AM, Baker L. Modeling Infectious Behaviors: The Need to Account for Behavioral Adaptation in COVID-19 Models. POLICY AND COMPLEX SYSTEMS 2021; 7:21-32. [PMID: 35582113 PMCID: PMC9109616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Mac S, Mishra S, Ximenes R, Barrett K, Khan YA, Naimark DMJ, Sander B. Modeling the coronavirus disease 2019 pandemic: A comprehensive guide of infectious disease and decision-analytic models. J Clin Epidemiol 2020; 132:133-141. [PMID: 33301904 PMCID: PMC7837043 DOI: 10.1016/j.jclinepi.2020.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Stephen Mac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada
| | - Sharmistha Mishra
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada; Escola de Matemática Aplicada, Fundação Getúlio Vargas, Rio de Janeiro, Brazil
| | - Kali Barrett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada
| | - Yasin A Khan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada
| | - David M J Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada; Public Health Ontario, Toronto, Canada; ICES, Toronto, Canada.
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Bansal A, Padappayil RP, Garg C, Singal A, Gupta M, Klein A. Utility of Artificial Intelligence Amidst the COVID 19 Pandemic: A Review. J Med Syst 2020; 44:156. [PMID: 32740678 PMCID: PMC7395799 DOI: 10.1007/s10916-020-01617-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/15/2020] [Indexed: 01/07/2023]
Abstract
The term machine learning refers to a collection of tools used for identifying patterns in data. As opposed to traditional methods of pattern identification, machine learning tools relies on artificial intelligence to map out patters from large amounts of data, can self-improve as and when new data becomes available and is quicker in accomplishing these tasks. This review describes various techniques of machine learning that have been used in the past in the prediction, detection and management of infectious diseases, and how these tools are being brought into the battle against COVID-19. In addition, we also discuss their applications in various stages of the pandemic, the advantages, disadvantages and possible pit falls.
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Affiliation(s)
- Agam Bansal
- Internal Medicine, Cleveland Clinic, Cleveland, OH USA
| | | | - Chandan Garg
- Deptartment of Statistics, Columbia University, New York, NY USA
| | - Anjali Singal
- Deptartment of Anatomy, All India Institute of Medical Sciences, Bathinda, India
| | - Mohak Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Allan Klein
- Deptartment of Cardiology, Cleveland Clinic, Cleveland, OH USA
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Lutz CS, Huynh MP, Schroeder M, Anyatonwu S, Dahlgren FS, Danyluk G, Fernandez D, Greene SK, Kipshidze N, Liu L, Mgbere O, McHugh LA, Myers JF, Siniscalchi A, Sullivan AD, West N, Johansson MA, Biggerstaff M. Applying infectious disease forecasting to public health: a path forward using influenza forecasting examples. BMC Public Health 2019; 19:1659. [PMID: 31823751 PMCID: PMC6902553 DOI: 10.1186/s12889-019-7966-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/19/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Infectious disease forecasting aims to predict characteristics of both seasonal epidemics and future pandemics. Accurate and timely infectious disease forecasts could aid public health responses by informing key preparation and mitigation efforts. MAIN BODY For forecasts to be fully integrated into public health decision-making, federal, state, and local officials must understand how forecasts were made, how to interpret forecasts, and how well the forecasts have performed in the past. Since the 2013-14 influenza season, the Influenza Division at the Centers for Disease Control and Prevention (CDC) has hosted collaborative challenges to forecast the timing, intensity, and short-term trajectory of influenza-like illness in the United States. Additional efforts to advance forecasting science have included influenza initiatives focused on state-level and hospitalization forecasts, as well as other infectious diseases. Using CDC influenza forecasting challenges as an example, this paper provides an overview of infectious disease forecasting; applications of forecasting to public health; and current work to develop best practices for forecast methodology, applications, and communication. CONCLUSIONS These efforts, along with other infectious disease forecasting initiatives, can foster the continued advancement of forecasting science.
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Affiliation(s)
- Chelsea S Lutz
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
- Oak Ridge Institute for Science and Education, United States Department of Energy, Oak Ridge, TN, 37830, USA.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Mimi P Huynh
- Infectious Disease Program, Council of State and Territorial Epidemiologists, Atlanta, GA, 30345, USA
| | - Monica Schroeder
- Infectious Disease Program, Council of State and Territorial Epidemiologists, Atlanta, GA, 30345, USA
| | - Sophia Anyatonwu
- PHI/CDC Global Health Fellowship Program, Public Health Institute, Oakland, CA, 94607, USA
| | - F Scott Dahlgren
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Gregory Danyluk
- Florida Department of Health in Polk County, Bartow, FL, 33830, USA
| | - Danielle Fernandez
- Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, FL, 33126, USA
| | - Sharon K Greene
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
| | | | - Leann Liu
- Office of Science, Surveillance, and Technology, Harris County Public Health, Houston, TX, 77027, USA
| | - Osaro Mgbere
- Disease Prevention and Control Division, Houston Health Department, Houston, TX, 77054, USA
| | - Lisa A McHugh
- Communicable Disease Service, New Jersey Department of Health, Trenton, NJ, 08608, USA
| | - Jennifer F Myers
- Infectious Diseases Branch, California Department of Public Health, Richmond, CA, 94804, USA
| | - Alan Siniscalchi
- Infectious Disease Section, Epidemiology & Emerging Infections Program, State of Connecticut Department of Health, Hartford, CT, 06134, USA
| | - Amy D Sullivan
- Division of Prevention and Community Health, Washington State Department of Health, Olympia, WA, 98504, USA
| | - Nicole West
- Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, OR, 97232, USA
| | - Michael A Johansson
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, PR, 00920, USA
| | - Matthew Biggerstaff
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
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