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Influenza Antibody Levels Associated with Laboratory-Confirmed Influenza in a Test-Negative Study Design, US Flu VE
Brendan Flannery1, Jessie R Chung1, Crystal Holiday1
1Centers for Disease Control and Prevention, Atlanta, GA, USA.
Medrxiv : the Preprint Server for Health Sciences
|April 3, 2026
Summary
Higher antibody levels against circulating influenza viruses correlate with a reduced likelihood of infection in adults. This study highlights the protective role of antibodies in preventing symptomatic influenza illness.
Area of Science:
- Immunology
- Virology
- Epidemiology
Background:
- Assessing the relationship between antibody concentrations and influenza virus infection in outpatients.
- Utilizing a test-negative study design to evaluate influenza virus infection associations.
Purpose of the Study:
- To determine the association between antibody concentrations and laboratory-confirmed influenza virus infection.
- To evaluate the protective effect of antibody titers against circulating influenza strains.
Main Methods:
- Collected serum and respiratory specimens from outpatients with acute respiratory illness.
- Measured influenza antibody titers using hemagglutination inhibition (HI), microneutralization (MN), and neuraminidase inhibition (NAI) assays.
- Employed logistic regression to estimate the reduction in odds of confirmed influenza with increasing antibody titers, adjusting for vaccination status and time since season start.
Main Results:
- Higher antibody titers against influenza hemagglutinin or neuraminidase proteins were linked to lower odds of influenza infection.
- Antibody titers against circulating viruses showed stronger associations with protection than those against vaccine reference viruses.
- Specific antibody titers (HI, NAI, MN) demonstrated significant reductions in the odds of infection for influenza A(H1N1)pdm09 and A(H3N2).
Conclusions:
- Elevated influenza antibody titers against circulating viruses are associated with a decreased likelihood of influenza infection in adults.
- The findings underscore the importance of antibody responses in protection against symptomatic influenza.
