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Tim K. Tsang, Simon Cauchemez, Ranawaka A. P. M. Perera, Guy Freeman, Vicky J. Fang, Dennis K. M. Ip, Gabriel M. Leung, Joseph Sriyal Malik Peiris, Benjamin J. Cowling, Association Between Antibody Titers and Protection Against Influenza Virus Infection Within Households, The Journal of Infectious Diseases, Volume 210, Issue 5, 1 September 2014, Pages 684–692, https://doi.org/10.1093/infdis/jiu186
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Abstract
Background. Previous studies have established that antibody titer measured by the hemagglutination-inhibiting (HAI) assay is correlated with protection against influenza virus infection, with an HAI titer of 1:40 generally associated with 50% protection.
Methods. We recruited index cases with confirmed influenza virus infection from outpatient clinics, and followed up their household contacts for 7–10 days to identify secondary infections. Serum samples collected from a subset of household contacts were tested by HAI and microneutralization (MN) assays against prevalent influenza viruses. We analyzed the data using an individual hazard-based transmission model that adjusted for age and vaccination history.
Results. Compared to a reference group with antibody titers <1:10, we found that HAI titers of 1:40 against influenza A(H1N1) and A(H3N2) were associated with 31% (95% confidence interval [CI], 13%–46%) and 31% (CI, 1%–53%) protection against polymerase chain reaction (PCR)–confirmed A(H1N1) and A(H3N2) virus infection, respectively, while an MN titer of 1:40 against A(H3N2) was associated with 49% (95% CI, 7%–81%) protection against PCR-confirmed A(H3N2) virus infection.
Conclusions. An HAI titer of 1:40 was associated with substantially less than 50% protection against PCR-confirmed influenza virus infection within households, perhaps because of exposures of greater duration or intensity in that confined setting.