Explaining rapid reinfections in multiple-wave influenza outbreaks: Tristan da Cunha 1971 epidemic as a case study

Camacho, Anton; Ballesteros, Sébastien; Graham, Andrea L.; Carrat, Fabrice; Ratmann, Oliver; Cazelles, Bernard

Finally, our results advocate a better account of host heterogeneity in the analysis of multiple-wave outbreaks. In particular, studies assuming that the immune response always provides a long-term humoral protection should overestimate the amount of immune escape required to sequential influenza variants to cause rapid reinfection [6] and multiple-wave outbreaks [8] . Put another way, our results may have important implications in the current context of influenza post-pandemic. Notably, the AoN mechanism, in addition to antigenic drift and compensatory mutations, would contribute to break population herd immunity by increasing the effective reproduction number of subsequent 2009 H1N1 influenza variants (electronic supplementary material, text S7). If empirically validated, these novel interactions should be included in epidemiological models aimed at pandemic planning and real-time risk prediction for influenza.