Emily Toth Martin
· Professor, EpidemiologyVerifiedUniversity of Michigan · Epidemiology
Active 1977–2025
About
Emily Toth Martin, PhD, MPH, is a Professor of Epidemiology at the U-M School of Public Health and serves as the Director of Doctoral Studies in Epidemiology. Her research focuses on infectious diseases and respiratory viruses, including influenza, SARS-CoV-2, and RSV, with an emphasis on strategies to prevent and treat infections. Her work includes studies of vaccine effectiveness and virus transmission in community, hospital, and ambulatory settings. Dr. Martin's scientific contributions involve improving observational designs for measuring vaccine effectiveness and conducting immunologic studies of correlates of protection. Her research encompasses epidemiology and transmission of respiratory viruses, with active surveillance studies evaluating patterns of viral transmission in households, child cares, and other settings. She oversees a large field team and laboratory supporting virus detection and immune correlates. Dr. Martin is a core investigator for several CDC networks and the NIAID Centers of Excellence for Influenza Research and Response. Her work aims to build a greater understanding of viral respiratory disease epidemiology and the effectiveness of vaccines, utilizing virus surveillance and molecular epidemiology to identify strategies to reduce infections. She has contributed to outbreak response efforts, rapid deployment of molecular surveillance, and environmental mitigation strategies in childcare settings. Her research also includes studying RSV epidemiology and evaluating vaccine and prophylactic strategies for this virus.
Research topics
- Medicine
- Internal medicine
- Computer Science
- Political Science
- Geography
- Artificial Intelligence
- Pediatrics
- Virology
- Econometrics
- Economics
- Business
- Engineering
- Machine Learning
- Actuarial science
- Immunology
- Gastroenterology
- Operations research
- Statistics
- Meteorology
- Emergency medicine
- Data science
- Environmental health
- World Wide Web
- Mathematics
Selected publications
medRxiv · 2025-03-15
preprintOpen accessSenior authorAbstract Background The first RSV vaccines for adults 60 years and older were approved prior to the 2023-2024 respiratory virus season. This study used data from adults 60 years and older, enrolled into the Community Vaccine Effectiveness (CoVE) cohort study, in Michigan, U.S.A, to evaluate RSV vaccine effectiveness (VE) and antibody correlates of protection. Methods A Cox proportional hazards model was used to compare incidence of symptomatic / all RSV infections in those vaccinated versus unvaccinated. RSV-specific (preF) binding antibodies were measured in serum specimens and assessed longitudinally. A correlates of protection analysis was conducted using logistic regression. Findings Of the 281 participants (n=117 vaccinated) enrolled (August 1, 2023, to March 1, 2024), 14 tested positive for RSV. Adjusted RSV VE against any RSV infection was 50.8% (95%CI: −79.1% to 86.5%), and 59.8% (95%CI: −105.2% to 92.1%) against symptomatic RSV. There were 61.2 (95%CI: 16.9, 163.2) RSV infections per 1,000 person-years among vaccinated participants compared to 165.8 infections (95%CI: 88.0, 287.0) per 1,000 person-years among those unvaccinated. A 31% decrease in odds (OR: 0.69, 95% CI: 0.44 to 1.07) of RSV infection per 2–fold increase in antibody concentration was observed. Interpretation RSV infection risk was lower among those with higher antibody titers. RSV incidence was lowest among vaccinated adults, but not significantly. Continued monitoring of reduction of RSV infection in years following vaccination is warranted. Funding National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention (75D30122C13149) and National Institute of Allergy and Infectious Diseases (75N93021C00015). The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
MMWR Morbidity and Mortality Weekly Report · 2025-02-27 · 70 citations
articleOpen accessCOVID-19 vaccination averted approximately 68,000 hospitalizations during the 2023-24 respiratory season. In June 2024, CDC and the Advisory Committee on Immunization Practices (ACIP) recommended that all persons aged ≥6 months receive a 2024-2025 COVID-19 vaccine, which targets Omicron JN.1 and JN.1-derived sublineages. Interim effectiveness of 2024-2025 COVID-19 vaccines was estimated against COVID-19-associated emergency department (ED) or urgent care (UC) visits during September 2024-January 2025 among adults aged ≥18 years in one CDC-funded vaccine effectiveness (VE) network, against COVID-19-associated hospitalization in immunocompetent adults aged ≥65 years in two networks, and against COVID-19-associated hospitalization among adults aged ≥65 years with immunocompromising conditions in one network. Among adults aged ≥18 years, VE against COVID-19-associated ED/UC visits was 33% (95% CI = 28%-38%) during the first 7-119 days after vaccination. Among immunocompetent adults aged ≥65 years from two CDC networks, VE estimates against COVID-19-associated hospitalization were 45% (95% CI = 36%-53%) and 46% (95% CI = 26%-60%) during the first 7-119 days after vaccination. Among adults aged ≥65 years with immunocompromising conditions in one network, VE was 40% (95% CI = 21%-54%) during the first 7-119 days after vaccination. These findings demonstrate that vaccination with a 2024-2025 COVID-19 vaccine dose provides additional protection against COVID-19-associated ED/UC encounters and hospitalizations compared with not receiving a 2024-2025 dose and support current CDC and ACIP recommendations that all persons aged ≥6 months receive a 2024-2025 COVID-19 vaccine dose.
Clinical Infectious Diseases · 2025-09-25 · 3 citations
articleOpen accessBACKGROUND: While influenza A(H3N2)-predominant seasons tend to have increased rates of influenza-associated hospitalizations and deaths, little is known about differences in clinical presentation and hospitalization outcomes by influenza type and subtype. METHODS: Data from hospitalized adults aged ≥18 years in 4 US states from 2017 to 2020 were used to evaluate the association between influenza type/subtype and severe influenza presentation and outcomes. Log binomial regression and modified Poisson regression with robust error variance were used to estimate adjusted risk ratios (aRRs) for clinical indicators within 24 hours of hospital admission and severity outcomes. Multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios for length of hospital stay and intensive care unit (ICU) stay. All models were adjusted for underlying conditions, age group, influenza vaccination, and site. RESULTS: People with influenza A(H1N1) were more likely to be admitted to an ICU (aRR = 1.42) than people with A(H3N2). People with influenza A(H1N1) had higher risk of hypoxemia (SpO2 <90%) than people with A(H3N2) (aRR = 1.24) and B (aRR = 1.43). People with influenza A(H1N1) compared with A(H3N2) also had higher risk of hyponatremia (sodium < 135 mmol/L; aRR = 1.19) and compared with B had higher risk of fever (>38°C, aRR = 1.56). CONCLUSIONS: Adult people hospitalized with influenza A(H1N1) had a higher risk of multiple severity indicators. Better understanding of influenza severity related to both host and virus type is important for reducing the burden of severe influenza in adults.
The Journal of Infectious Diseases · 2025-04-03 · 4 citations
articleOpen accessSenior authorBACKGROUND: Little is known about the strength and durability of protection provided by prefusion F (pre-F) immunoglobulin G (IgG) after respiratory syncytial virus (RSV) infection/exposure. METHODS: We analyzed 1019 sera from 422 individuals in 173 households, collected 365 days before and after RSV infection or exposure (2014-2022), from a longitudinal cohort with active respiratory infection surveillance. IgG against RSV pre-F was measured by electrochemiluminescence assay. We used a Cox model, adjusted for age, to assess the association between log4 preinfection/exposure IgG and risk of infection. We compared pre- and postinfection/exposure IgG geometric mean concentration increases among cases and household contacts to identify asymptomatic infections. Generalized additive mixed models predicted IgG concentrations over time. RESULTS: We identified 113 confirmed RSV cases and 377 exposed household contacts. Cases had significantly lower pre-F IgG before infection (P < .05) and significantly higher levels after infection (P < .05). A 1-unit increase in log4 preinfection IgG decreased the risk of infection by 25% (P < .05). Among 58 cases with pre- to post-RSV geometric mean concentration increases, the mean fold increase was 1.12. Eight individuals without confirmed infections had ≥1.12-fold increases and were classified as probable asymptomatic infections. Cases had the highest IgG concentrations after infection, peaking at 1 month (P < .001). CONCLUSIONS: Pre-F IgG is a reliable correlate of protection for RSV infection risk. We found that RSV pre-F IgG-mediated protection starts to wane 6 months after infection. Therefore, scheduling of RSV vaccination should be evaluated so that individuals with the highest risk of severe disease are protected throughout the RSV season.
Clinical Infectious Diseases · 2025-10-15
articleBACKGROUND: Estimates of annual effectiveness of influenza vaccination combine multiple vaccine types. Reports of brand/product-specific vaccine effectiveness (VE) of egg- and cell-culture based quadrivalent inactivated influenza vaccines (IIV4/ccIIV4) are limited. METHODS: Using an observational test-negative study design, we compared effectiveness of selected IIV4 and ccIIV4 products among outpatients enrolled in the US Flu VE Network from 2014-2015 to 2018-2019. We used multivariable logistic regression to estimate product- and age-group-specific absolute and relative effectiveness of recommended, age-appropriate vaccines against symptomatic laboratory-confirmed outpatient influenza. Relative effectiveness of ccIIV4 versus IIV4 products was estimated during two seasons from 2017-2019 among participants aged ≥4 years. RESULTS: Pooling data from five influenza seasons when 18% and 15% of vaccinated patients had received Fluarix® Quadrivalent or Fluzone® Quadrivalent IIV4, respectively, VE against influenza was 32% for Fluarix IIV4 and 37% for Fluzone IIV4. Pooling two seasons when 11% and 28% of vaccinated patients had received ccIIV4/Flucelvax® Quadrivalent and FluLaval® Quadrivalent IIV4, respectively, VE against influenza for each product was 30%. Absolute VE compared to unvaccinated patients was lowest against influenza A(H3N2) compared to that against A(H1N1)pdm09 and each B lineage; VE point estimates were lowest among patients aged ≥50 years compared to two younger age-groups. Relative effectiveness estimates were not statistically significant, indicating similar protection across vaccine products. CONCLUSION: Comparisons of influenza vaccine products over multiple seasons showed benefit against symptomatic laboratory-confirmed outpatient influenza of both egg- and cell culture-based quadrivalent inactivated influenza vaccines, with similar absolute and relative levels of protection provided by each product.
EBioMedicine · 2025-10-11 · 5 citations
articleOpen accessSenior authorBACKGROUND: The first RSV vaccines for adults 60 years and older were approved prior to the 2023-2024 respiratory virus season. This study aims to evaluate RSV vaccine effectiveness (VE) in preventing RSV infections among older adults, and to examine antibody correlates of protection. METHODS: This study used data from adults 60 years and older, enrolled into the Community Vaccine Effectiveness (CoVE) prospective cohort study, in Michigan, U.S.A. A Cox regression model was used to compare incidence of symptomatic/all RSV infections in those vaccinated versus unvaccinated. RSV-specific (preF) binding antibodies were measured in serum specimens and assessed longitudinally. A correlates of protection analysis was conducted using logistic regression. FINDINGS: Of the 281 participants (n = 117 vaccinated) enrolled (August 1, 2023, to March 1, 2024), 14 tested positive for RSV. Adjusted RSV VE against any RSV infection was 50.8% (95% CI: -79.1% to 86.5%), and 59.8% (95% CI: -105.2% to 92.1%) against symptomatic RSV. There were 61.2 (95% CI: 16.9, 163.2) RSV infections per 1000 person-years among participants who were vaccinated compared to 165.8 infections (95% CI: 88.0, 287.0) per 1000 person-years among those unvaccinated. A 31% decrease in odds (OR: 0.69, 95% CI: 0.44-1.07) of RSV infection per 2-fold increase in antibody concentration was observed. INTERPRETATION: Our findings suggest that higher antibody levels may be associated with a reduced risk of RSV infection, but further research is needed to confirm this relationship. RSV incidence appeared to be lowest among adults who were vaccinated, though the difference was not statistically significant. Low number of RSV events and limited availability of serology data limit the precision of the estimates. Continued monitoring of reduction of RSV infection in years following vaccination is warranted. FUNDING: National Center for Immunisation and Respiratory Diseases, U.S. Centers for Disease Control and Prevention (75D30122C13149) and National Institute of Allergy and Infectious Diseases (75N93021C00015). The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
medRxiv · 2025-05-26
preprintOpen accessSenior authorBackground: Reduced influenza transmission during the COVID-19 pandemic prompted concern about waning of population immunity that could lead to subsequent surges in circulation. We evaluated this by comparing longitudinal influenza antibody titers in Michigan and Hong Kong, two regions with reduced influenza transmission during the COVID-19 pandemic. Methods: In two prospective cohort studies (HIVE, Michigan; EPI-HK, Hong Kong), we analyzed longitudinal serum samples collected from 2020 through 2023 from participants without documented influenza virus infection or vaccination. Sera were tested using hemagglutination inhibition assays (HAI) against relevant vaccine strains. Geometric mean titers (GMTs) and fold changes were estimated by region and time. Linear mixed-effects models were used to assess temporal trends. Results: We analyzed 173 sera from 57 HIVE participants and 259 sera from 60 EPI-HK participants. Initial GMTs in 2020-21 ranged from 12.3-123.4 in HIVE and 6.3-40.9 in EPI-HK (B/Yamagata-H1N1). Fold changes in GMTs ranged from 1.2-2.6 in HIVE and 0.7-1.0 in EPI-HK. In HIVE models, no significant change in HAI titers over time was detected. In EPI-HK, small but statistically significant monthly declines were observed for select H1N1 (A/Michigan) and H3N2 (A/Hong Kong) strains (e.g., A/Hong Kong: -0.98%, 95% CI: -1.82% to -0.11%). Conclusion: Minimal HAI titer waning was observed in both regions. In some cases, antibody levels increased in Michigan, possibly indicating cryptic circulation of strains prior to the 2022/23 influenza season. These findings do not support an "immunity debt" during pandemic restrictions and could help explain the lack of a substantial surge in influenza impact after the COVID-19 pandemic.
The Journal of Infectious Diseases · 2025-12-02
articleBACKGROUND: Adult studies have shown that quadrivalent recombinant influenza vaccines (RIV4) induce a higher antibody response than quadrivalent egg-based inactivated influenza vaccines (IIV4). METHODS: Healthcare personnel (HCP) from a 2018-2019 cohort study that assessed IIV4 immunogenicity in Israel were recruited into a 2019-2020 randomized trial of RIV4 and IIV4. 2018-2019 low titer low responders (LTLRs) had pre-vaccination hemagglutination inhibition antibody titers ≤1:40 and <4-foldrise post-vaccination. We assessed whether RIV4 versus IIV4 receipt in the 2019-2020 season improved response among 2018-2019 LTLRs using logistic regression adjusted for employment hospital. RESULTS: Of 228 HCP classified as 2018-2019 LTLRs, 2019-2020 RIV4 recipients were 3.6 (95% CI: 1.2-11.4) and 8.3 (95% CI: 3.0-26.3) times as likely to become a non-LTLR against influenza A(H1N1)pdm09 and cell-derived A(H3N2) vaccine components compared to IIV4 recipients. CONCLUSIONS: RIV4 had improved immunogenicity against influenza A viruses among previously classified low vaccine responder HCP, highlighting how recombinant influenza vaccines could improve antibody responses against influenza A for HCP at risk for poor influenza antibody response.
Genomic Characterization of RSV in the US by Vaccination Status
JAMA · 2025-03-10 · 8 citations
articleOpen accessThis study examines respiratory syncytial virus (RSV) genomic surveillance results from 2 large US networks after the introduction of RSV vaccines.
Multimorbidity Profiles and Severe In-Hospital Outcomes in Adults with Respiratory Syncytial Virus
medRxiv · 2025-05-06
preprintOpen accessAbstract Background Adults hospitalized with acute respiratory infections, including respiratory syncytial virus (RSV), often have multiple underlying conditions. Few data are available on the combined effect of conditions on risk of severe outcomes from RSV disease. Methods We enrolled adults hospitalized with RSV at 26 hospitals in 20 US states admitted January 2022–July 2024. Seventeen underlying conditions were selected after excluding those with rare prevalence (≤1%) or high pairwise correlation (≥0.7). We applied Bayesian profile regression to identify profiles of conditions associated with increased risk of RSV severe outcomes, stratifying among adults aged 18–59 and ≥60 years. Results We analyzed data from 1111 adults hospitalized with RSV (median age [IQR] = 66 [53–75]). Among 397 adults aged 18–59 years, two profiles were identified: (1) minimal prevalence with fewer underlying conditions and a posterior median ICU admission risk of 21% (95% credible interval = [16‒25]); (2) cardiorenal/diabetes with frequent heart failure, chronic kidney disease, diabetes, and increased ICU admission risk (37% [27‒48]). Among 714 adults aged ≥60 years, four profiles were identified: (1) minimal prevalence (ICU admission risk = 22% [18‒ 26]), (2) cardiorenal/diabetes (27% [21‒34]), (3) hematologic malignancy and transplant receipt (12% [6‒21]), and (4) chronic pulmonary disease with home oxygen dependence (44% [25‒66]). Conclusion Distinct underlying condition profiles with varying risks of critical illness were observed among inpatients with RSV. These findings could support recognition of high-risk patients to inform RSV prevention strategies and suggest the role of multimorbidity in severe RSV disease risk warrants further attention. Summary In this prospective, multicenter analysis of >1,100 adults hospitalized with RSV, patients with multiple underlying conditions were common and partitioned into distinct multimorbidity profiles with varying risks of RSV critical illness.
Recent grants
Defining Precursors to VRSA Emergence: Epidemiology of MRSA & VRE Dual Infection
NIH · $641k · 2012–2017
Frequent coauthors
- 2318 shared
Manjusha Gaglani
Baylor Scott & White Health
- 2062 shared
Adam S. Lauring
New York Proton Center
- 2000 shared
Los Angeles
KU Leuven
- 1997 shared
Yuwei Zhu
Vanderbilt University Medical Center
- 1988 shared
Wesley H. Self
Vanderbilt University Medical Center
- 1986 shared
Adit A. Ginde
University of Colorado Denver
- 1985 shared
Kevin W. Gibbs
Wake Forest University
- 1887 shared
Natasha Halasa
Vanderbilt University Medical Center
Awards & honors
- 2021 UM Presidential Award for State and National Leadership
- UM Institute for Healthcare Policy and Innovation Impact Acc…
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