Antibody responses to influenza A(H1N1)pdm infection

• Published in: Vaccine Vol. 38; no. 27; pp. 4221 - 4225
• Main Authors: Wraith, Steph, Nachbagauer, Raffael, Balmaseda, Angel, Stadlbauer, Daniel, Ojeda, Sergio, Rajabhathor, Arvind, Lopez, Roger, Guglia, Andrea F., Sanchez, Nery, Amanat, Fatima, Gresh, Lionel, Kuan, Guillermina, Krammer, Florian, Gordon, Aubree
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 02-06-2020; Elsevier Limited
• Subjects: Age; Antibodies; Antibodies, Viral; Antibody Formation; Antibody response; Exo-a-sialidase; Hemagglutination inhibition; Hemagglutination Inhibition Tests; Hemagglutinin Glycoproteins, Influenza Virus; Hemagglutinins; Humans; Immune response; Immune response (humoral); Infections; Influenza; Influenza A; Influenza A Virus, H1N1 Subtype; Influenza Vaccines; Influenza, Human; Laboratories; Neuraminidase; Population; Statistical analysis; Studies; Vaccines; United States > US; Nicaragua; California; Antibodies; Hemagglutination inhibition; Influenza; Neuraminidase
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2020.04.069

•Not all influenza-infected people generate hemagglutination inhibition antibodies.•A subset of individuals respond exclusively to alternate viral targets of infection.•Including neuraminidase and hemagglutinin stalk could improve the influenza vaccine.
We investigated humoral immune response to influenza A(H1N1)pdm infection and found 32 (22%) of the infected individuals identified by PCR failed to produce a ≥ 4-fold hemagglutinin inhibition assay (HAI) response; a subset of 18 (56%) produced an alternate antibody response (against full-length HA, HA stalk, or neuraminidase). These individuals had lower pre-existing HAI antibody titers and showed a pattern of milder illness. An additional subset of 14 (44%) did not produce an alternate antibody response, had higher pre-existing antibody titers against full-length & stalk HA, and were less sick. These findings demonstrate that some individuals mount an alternate antibody response to influenza infection. In order to design more broadly protective influenza vaccines it may be useful to target these alternate sites. These findings support that there are influenza cases currently being missed by solely implementing HAI assays, resulting in an underestimation of the global burden of influenza infection.