Abstract
The age distribution of influenza A(H5N1) cases reported during 2006-2013 varied substantially between countries. As well as underlying demographic profiles, it is possible that cross-immunity contributed to the age distribution of reported cases: seasonal influenza A(H1N1) and avian influenza A(H5N1) share the same neuraminidase subtype, N1. Using a mechanistic model, we measured the extent to which population age distribution and heterosubtypic cross-immunity could explain the observed age patterns in Cambodia, China, Egypt, Indonesia and Vietnam. Our results support experimental evidence that prior infection with H1N1 confers partial cross-immunity to H5N1, and suggest that more than 50% of spillover events did not lead to reported cases of infection as a result. We also identified age groups that have additional risk factors for influenza A(H5N1) not captured by demography or infection history.
Highlights
If reported spillover events occurred at an equal rateThe potential for highly pathogenic infections to transmit from animals to humans is a major public health concern [1, 2]
Influenza A (H1N1) and A(H5N1) viruses share the same neuraminidase subtype, N1, and there is evidence that H1N1 neuraminidase antibodies cross-react with H5N1 viruses [6,7,8]
We found that models that included cross-immunity between influenza A(H1N1) and A(H5N1) performed much better than the others we considered (Table 1)
Summary
If reported spillover events occurred at an equal rateThe potential for highly pathogenic infections to transmit from animals to humans is a major public health concern [1, 2]. Between 1 January 2006 and 1 December 2013, a total of 500 confirmed influenza A(H5N1) cases were reported to the World Health Organization. The age distribution of cases varied substantially between countries [3,4,5]. There were a disproportionally high number of cases of influenza A(H5N1) in the
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