Abstract
BackgroundThe rate of decline of antibody titers to influenza following infection can affect results of serological surveys, and may explain re-infection and recurrent epidemics by the same strain.MethodsWe followed up a cohort who seroconverted on hemagglutination inhibition (HI) antibody titers (≥4-fold increase) to pandemic influenza A(H1N1)pdm09 during a seroincidence study in 2009. Along with the pre-epidemic sample, and the sample from 2009 with the highest HI titer between August and October 2009 (A), two additional blood samples obtained in April 2010 and September 2010 (B and C) were assayed for antibodies to A(H1N1)pdm09 by both HI and virus microneutralization (MN) assays. We analyzed pair-wise mean-fold change in titers and the proportion with HI titers ≥ 40 and MN ≥ 160 (which correlated with a HI titer of 40 in our assays) at the 3 time-points following seroconversion.ResultsA total of 67 participants contributed 3 samples each. From the highest HI titer in 2009 to the last sample in 2010, 2 participants showed increase in titers (by HI and MN), while 63 (94%) and 49 (73%) had reduction in HI and MN titers, respectively. Titers by both assays decreased significantly; while 70.8% and 72.3% of subjects had titers of ≥ 40 and ≥ 160 by HI and MN in 2009, these percentages decreased to 13.9% and 36.9% by September 2010. In 6 participants aged 55 years and older, the decrease was significantly greater than in those aged below 55, so that none of the elderly had HI titers ≥ 40 nor MN titers ≥ 160 by the final sample. Due to this decline in titers, only 23 (35%) of the 65 participants who seroconverted on HI in sample A were found to seroconvert between the pre-epidemic sample and sample C, compared to 53 (90%) of the 59 who seroconverted on MN on Sample A.ConclusionsWe observed marked reduction in titers 1 year after seroconversion by HI, and to a lesser extent by MN. Our findings have implications for re-infections, recurrent epidemics, vaccination strategies, and for cohort studies measuring infection rates by seroconversion.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-414) contains supplementary material, which is available to authorized users.
Highlights
The rate of decline of antibody titers to influenza following infection can affect results of serological surveys, and may explain re-infection and recurrent epidemics by the same strain
This study aimed to determine the possible waning of post-infection antibodies by quantifying the rate of decline in a cohort of individuals who seroconverted to A (H1N1)pdm09, and were followed up at two additional time-points, i.e. approximately 6 months and 1 year after seroconversion
Each participant contributed a baseline pre-epidemic sample and up to two follow-up samples to determine whether they seroconverted to A(H1N1)pdm09 from June to October 2009, when Singapore experienced the initial epidemic of A(H1N1)pdm09 infections
Summary
The rate of decline of antibody titers to influenza following infection can affect results of serological surveys, and may explain re-infection and recurrent epidemics by the same strain. One empirical study has shown a decline in antibody titers, with only 52% of naturally infected and 34% of vaccinated individuals having hemagglutination inhibition (HI) titers of ≥ 40 after 6 months of follow-up [10]. Another smaller study including both naturally infected and vaccinated individuals reported a less dramatic decrease, with only about 5% showing a 4-fold or greater decline in antibody titers after ~1 year by both HI and virus microneutralization (MN) assays [11]. Several cohort studies have suggested that a substantial proportion of influenza infections are asymptomatic [14,15,16,17], but it is unclear if the immune responses in such infections are as robust and durable as those observed in symptomatic influenza
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