Abstract
The period of protection from repeat infection following symptomatic influenza is not well established due to limited availability of longitudinal data. Using data from a pediatric cohort in Managua, Nicaragua, we examine the effects of natural influenza virus infection on subsequent infection with the same influenza virus subtype/lineage across multiple seasons, totaling 2,170 RT-PCR-confirmed symptomatic influenza infections. Logistic regression models assessed whether infection in the prior influenza season protected against homologous reinfection. We sequenced viruses from 2011–2019 identifying dominant clades and measuring antigenic distances between hemagglutinin clades. We observe homotypic protection from repeat infection in children infected with influenza A/H1N1pdm (OR 0.12, CI 0.02–0.88), A/H3N2 (OR 0.41, CI 0.24–0.73), and B/Victoria (OR 0.00, CI 0.00–0.14), but not with B/Yamagata viruses (OR 0.60, CI 0.09–2.10). Overall, protection wanes as time or antigenic distance increases. Individuals infected with one subtype or lineage of influenza virus have significantly lower odds of homologous reinfection for the following one to two years; after two years this protection wanes. This protection is demonstrated across multiple seasons, subtypes, and lineages among children.
Highlights
The period of protection from repeat infection following symptomatic influenza is not well established due to limited availability of longitudinal data
Influenza B lineages fluctuated between B/Yamagata and B/Victoria, with B/Victoria being more dominant in recent years when lineage typing was routinely available
For influenza B, the B/Victoria lineage clade was very stable throughout 2012–2017, while more genetic change occurred in B/Yamagata during 2014–2017
Summary
The period of protection from repeat infection following symptomatic influenza is not well established due to limited availability of longitudinal data. Individuals infected with one subtype or lineage of influenza virus have significantly lower odds of homologous reinfection for the following one to two years; after two years this protection wanes This protection is demonstrated across multiple seasons, subtypes, and lineages among children. The Cleveland and Houston family cohorts both conducted household-based studies to track outbreaks and characterize the incidence and noted the presence of protection from re-infection in some seasons but not others[13–15] While these historical studies laid important groundwork for the examination of homotypic protection, they were limited in both power and by the laboratory techniques of the time, which restricted the ability to time infection events precisely. For the development of next-generation influenza vaccines, it is critical to determine the extent of immunity conferred by natural infection[22–26] In this analysis, we explore interactions between patterns of virus drift and duration of time between infections, showing how these dynamics drive protection from symptomatic influenza infection
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