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\begin{document}

\title{Risk Factors for Infection with Influenza A(H3N2) virus on a US
University Campus, October--November 2021}



\author[1]{Nathaniel Lewis}%
\author[1]{Miranda Delahoy}%
\author[1]{Kelsey Sumner}%
\author[2]{Adam Lauring}%
\author[2]{Emily Bendall}%
\author[2]{Lindsey Mortenson}%
\author[2]{Aleksandra  Stamper}%
\author[2]{Elizabeth Edwards}%
\author[1]{Brendan Flannery}%
\author[3]{Emily Martin}%
\affil[1]{Centers for Disease Control and Prevention}%
\affil[2]{University of Michigan Medical School}%
\affil[3]{University of Michigan}%


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  \date{June 18, 2024}


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\begin{abstract}
Background: Knowledge of the specific dynamics of influenza introduction
and spread in university settings is limited. Methods: Persons with
acute respiratory illness symptoms received influenza testing by
molecular assay during October 6--November 23, 2022. Viral sequencing
and phylogenetic analysis were conducted on nasal swab samples from
case-patients. Case-control analysis of a voluntary survey of persons
tested was used to identify factors associated with influenza; logistic
regression was conducted to calculate odds ratios and 95\% CIs. A subset
of case-patients tested during the first month of the outbreak was
interviewed to identify sources of introduction and early spread.
Results: Among 3,268 persons tested, 788 (24.1\%) tested positive for
influenza; 744 (22.8\%) were included in the survey analysis. All 380
sequenced specimens were influenza A (H3N2) virus clade 3C.2a1b.2a.2,
suggesting rapid transmission. Influenza (OR {[}95\% CI{]}) was
associated with indoor congregate dining (1.43 {[}1.002--2.03{]}),
attending large gatherings indoors (1.83 {[}1.26--2.66{]}) or outdoors
(2.33 {[}1.64--3.31{]}), and varied by residence type (apartment with [?]1
roommate: 2.93 {[}1.21--7.11{]}, residence hall room alone: 4.18
{[}1.31--13.31{]}, or with roommate: 6.09 {[}2.46--15.06{]}, or
fraternity/sorority house: 15.13 {[}4.30--53.21{]}, all compared with
single-dwelling apartment). Odds of influenza were lower among persons
who left campus for [?]1 day during the week before their influenza test
(0.49 {[}0.32--0.75{]}). Almost all early cases reported attending large
events. Conclusions: Congregate living and activity settings on
university campuses can lead to rapid spread of influenza following
introduction. Isolating following a positive influenza test or
administering antiviral medications to exposed persons may help mitigate
outbreaks.%
\end{abstract}%



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\textbf{Hosted file}

\verb`Flu Risk Factor_IORV_final_Lewis.docx`  available at \url{https://authorea.com/users/593566/articles/628509-risk-factors-for-infection-with-influenza-a-h3n2-virus-on-a-us-university-campus-october-november-2021}\selectlanguage{english}
\begin{figure}[H]
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\includegraphics[width=0.70\columnwidth]{figures/Figure-1-IORV/Figure-1-IORV}

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\end{figure}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/Figure-2-IORV/Figure-2-IORV}

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\end{figure}

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