Evolution, transmission, and clinical impacts of SARS-CoV-2 and influenza viruses

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[EMBARGOED UNTIL 12/1/2024] Influenza and coronaviruses are leading causes of human respiratory diseases, causing substantial global impact. The ongoing evolution of SARS-CoV-2 and influenza viruses continues to trigger waves of outbreaks worldwide. Thus, understanding the natural history of influenza and SARS-CoV-2 viruses is crucial for effective prevention and rapid response to outbreaks. This dissertation explores the evolution, transmission, and clinical impacts of influenza and SARS-CoV-2 viruses and revealed four major findings. 1) the contemporary influenza B viruses showed genetic adaptations to cell and egg cultures, potentially impacting vaccine strain selection and vaccine development. 2) Rural communities were an important source for emerging SARS-CoV-2 variants and SARS-CoV-2 transmission. 3) We developed a machine learning model to predict COVID-19 outcomes, primarily hospitalization, intensive care unit admission, and long COVID. 4) Co-infections between SARS-CoV-2 and influenza viruses were highly prevalent in Central Missouri during the 2021-2022 flu season with differing rates between Delta and Omicron variants, and a link between influenza vaccination and reduced co-infections was also identified. Overall, these findings provided deeper insights into how an influenza and SARS-CoV-2 viruses emerge, evolve, and spread in humans and revealed how the intricate interplay between host, virus and environmental attributes affect disease severity of SARS-CoV-2 infection. Thus, these studies can enhance vaccine strain selection, refine strategies to address potential future pandemics, and advance the development of personalized medicine for seasonal outbreaks.

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