Epidemiology and Relative Severity of Influenza Subtypes in Singapore in the Post-Pandemic Period from 2009 to 2010.
Epidemiology and Relative Severity of Influenza Subtypes in Singapore in the Post-Pandemic Period from 2009 to 2010.
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DOI：
10.1093/cid/cix694
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发表时间：
2017-11-13
期刊：
影响因子：
--
通讯作者：
Chen MI
中科院分区：
文献类型：
--
作者：
Goh EH;Jiang L;Hsu JP;Tan LWL;Lim WY;Phoon MC;Leo YS;Barr IG;Chow VTK;Lee VJ;Lin C;Lin R;Sadarangani SP;Young B;Chen MI
我们评估并发现流感大流行和在新加坡流行的2种季节性病毒之间存在交叉保护。研究了亚型之间疾病严重程度的差异，我们证明了出生队列效应与抗原罪过理论一致。2009年后，大流行性流感A（H1N1）[A（H1N1）pdm 09]与A（H3 N2）和B在新加坡共同传播。2009年10月至2010年9月，760名参与者提供了人口统计学数据和最多4份血液样本。我们比较了3种亚型的流行病学，并通过多变量logistic回归使用广义估计方程研究了异型免疫的证据。为了检查亚型之间严重程度的年龄相关差异，我们使用了住院与感染比率的LOESS（局部加权平滑）图，并探索了参考大流行年份（1957年; 1968年）的出生队列效应。有更多的5-19岁的家庭成员和频繁使用公共交通工具增加了感染的风险，而针对相同亚型的预先存在的抗体（比值比[OR]，0.61; P = .002）和先前的流感感染对异型感染（OR，0.32; P = .045）具有保护作用。A（H1N1）pdm 09的严重程度在1957年左右出生的人中达到峰值，而A（H3 N2）的严重程度在最年轻的人中最低，并在1952年或更早出生的人中超过A（H1N1）pdm 09。进一步分析显示，1956年或更早出生的人A（H1N1）pdm 09的严重程度低于A（H3 N2）（P = 0.021），1968年或更晚出生的人反之亦然（P <0.001），1957年和1967年之间出生的人没有差异（P = 0.632）。我们的研究结果表明，儿童期暴露对免疫反应有长期影响，这与抗原罪过理论一致。这一点，再加上对短期交叉保护的观察，对疫苗接种和流感流行以及大流行缓解战略都有影响。
We assessed and found cross-protection between the influenza pandemic and 2 seasonal viruses that circulated in Singapore. Age-related differences in disease severity between the subtypes were investigated, and we demonstrate birth cohort effects consistent with the theory of antigenic sin. After 2009, pandemic influenza A(H1N1) [A(H1N1)pdm09] cocirculated with A(H3N2) and B in Singapore. A cohort of 760 participants contributed demographic data and up to 4 blood samples each from October 2009 to September 2010. We compared epidemiology of the 3 subtypes and investigated evidence for heterotypic immunity through multivariable logistic regression using a generalized estimating equation. To examine age-related differences in severity between subtypes, we used LOESS (locally weighted smoothing) plots of hospitalization to infection ratios and explored birth cohort effects referencing the pandemic years (1957; 1968). Having more household members aged 5–19 years and frequent public transport use increased risk of infection, while preexisting antibodies against the same subtype (odds ratio [OR], 0.61; P = .002) and previous influenza infection against heterotypic infections (OR, 0.32; P = .045) were protective. A(H1N1)pdm09 severity peaked in those born around 1957, while A(H3N2) severity was least in the youngest individuals and increased until it surpassed A(H1N1)pdm09 in those born in 1952 or earlier. Further analysis showed that severity of A(H1N1)pdm09 was less than that for A(H3N2) in those born in 1956 or earlier (P = .021) and vice versa for those born in 1968 or later (P < .001), with no difference in those born between 1957 and 1967 (P = .632). Our findings suggest that childhood exposures had long-term impact on immune responses consistent with the theory of antigenic sin. This, plus observations on short-term cross-protection, have implications for vaccination and influenza epidemic and pandemic mitigation strategies.
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