Kinetics of Serological Responses in Critically Ill Patients Hospitalized With 2009 Pandemic Influenza A(H1N1) Virus Infection in Canada, 2009-2011.
Identifieur interne : 000061 ( Main/Corpus ); précédent : 000060; suivant : 000062Kinetics of Serological Responses in Critically Ill Patients Hospitalized With 2009 Pandemic Influenza A(H1N1) Virus Infection in Canada, 2009-2011.
Auteurs : Melissa A. Rolfes ; F Liaini Gross ; Brendan Flannery ; Adrienne F A. Meyers ; Ma Luo ; Nathalie Bastien ; Robert A. Fowler ; Jacqueline M. Katz ; Min Z. Levine ; Anand Kumar ; Timothy M. UyekiSource :
- The Journal of infectious diseases [ 1537-6613 ] ; 2018.
English descriptors
- KwdEn :
- Adolescent, Adult, Aged, Antibodies, Viral (blood), Canada (epidemiology), Critical Illness, Female, Humans, Influenza A Virus, H1N1 Subtype (immunology), Influenza, Human (blood), Influenza, Human (epidemiology), Influenza, Human (mortality), Male, Middle Aged, Pandemics, Risk Factors, Seasons, Time Factors, Young Adult.
- MESH :
- chemical , blood : Antibodies, Viral.
- geographic , epidemiology : Canada.
- blood : Influenza, Human.
- epidemiology : Influenza, Human.
- immunology : Influenza A Virus, H1N1 Subtype.
- mortality : Influenza, Human.
- Adolescent, Adult, Aged, Critical Illness, Female, Humans, Male, Middle Aged, Pandemics, Risk Factors, Seasons, Time Factors, Young Adult.
Abstract
Background
The kinetics of the antibody response during severe influenza are not well documented.
Methods
Critically ill patients infected with 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09), confirmed by reverse-transcription polymerase chain reaction analysis or seroconversion (defined as a ≥4-fold rise in titers), during 2009-2011 in Canada were prospectively studied. Antibody titers in serially collected sera were determined using hemagglutinin inhibition (HAI) and microneutralization assays. Average antibody curves were estimated using linear mixed-effects models and compared by patient outcome, age, and corticosteroid treatment.
Results
Of 47 patients with A(H1N1)pdm09 virus infection (median age, 47 years), 59% had baseline HAI titers of <40, and 68% had baseline neutralizing titers of <40. Antibody titers rose quickly after symptom onset, and, by day 14, 83% of patients had HAI titers of ≥40, and 80% had neutralizing titers ≥40. Baseline HAI titers were significantly higher in patients who died compared with patients who survived; however, the antibody kinetics were similar by patient outcome and corticosteroid treatment. Geometric mean titers over time in older patients were lower than those in younger patients.
Conclusions
Critically ill patients with influenza A(H1N1)pdm09 virus infection had strong HAI and neutralizing antibody responses during their illness. Antibody kinetics differed by age but were not associated with patient outcome.
DOI: 10.1093/infdis/jiy013
PubMed: 29342251
Links to Exploration step
pubmed:29342251Le document en format XML
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Rolfes</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Gross, F Liaini" sort="Gross, F Liaini" uniqKey="Gross F" first="F Liaini" last="Gross">F Liaini Gross</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Battelle, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Flannery, Brendan" sort="Flannery, Brendan" uniqKey="Flannery B" first="Brendan" last="Flannery">Brendan Flannery</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Meyers, Adrienne F A" sort="Meyers, Adrienne F A" uniqKey="Meyers A" first="Adrienne F A" last="Meyers">Adrienne F A. Meyers</name><affiliation><nlm:affiliation>National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Medical Microbiology and Infectious Diseases, Winnipeg.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Medical Microbiology, University of Nairobi, Kenya.</nlm:affiliation></affiliation></author><author><name sortKey="Luo, Ma" sort="Luo, Ma" uniqKey="Luo M" first="Ma" last="Luo">Ma Luo</name><affiliation><nlm:affiliation>National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg.</nlm:affiliation></affiliation></author><author><name sortKey="Bastien, Nathalie" sort="Bastien, Nathalie" uniqKey="Bastien N" first="Nathalie" last="Bastien">Nathalie Bastien</name><affiliation><nlm:affiliation>National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg.</nlm:affiliation></affiliation></author><author><name sortKey="Fowler, Robert A" sort="Fowler, Robert A" uniqKey="Fowler R" first="Robert A" last="Fowler">Robert A. Fowler</name><affiliation><nlm:affiliation>Sunnybrook Hospital, Department of Critical Care Medicine, University of Toronto, Toronto, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Katz, Jacqueline M" sort="Katz, Jacqueline M" uniqKey="Katz J" first="Jacqueline M" last="Katz">Jacqueline M. Katz</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Levine, Min Z" sort="Levine, Min Z" uniqKey="Levine M" first="Min Z" last="Levine">Min Z. Levine</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Kumar, Anand" sort="Kumar, Anand" uniqKey="Kumar A" first="Anand" last="Kumar">Anand Kumar</name><affiliation><nlm:affiliation>Section of Critical Care Medicine, Winnipeg.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Section of Infectious Diseases, University of Manitoba, Winnipeg.</nlm:affiliation></affiliation></author><author><name sortKey="Uyeki, Timothy M" sort="Uyeki, Timothy M" uniqKey="Uyeki T" first="Timothy M" last="Uyeki">Timothy M. Uyeki</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2018">2018</date><idno type="RBID">pubmed:29342251</idno><idno type="pmid">29342251</idno><idno type="doi">10.1093/infdis/jiy013</idno><idno type="wicri:Area/Main/Corpus">000061</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000061</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Kinetics of Serological Responses in Critically Ill Patients Hospitalized With 2009 Pandemic Influenza A(H1N1) Virus Infection in Canada, 2009-2011.</title><author><name sortKey="Rolfes, Melissa A" sort="Rolfes, Melissa A" uniqKey="Rolfes M" first="Melissa A" last="Rolfes">Melissa A. Rolfes</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Gross, F Liaini" sort="Gross, F Liaini" uniqKey="Gross F" first="F Liaini" last="Gross">F Liaini Gross</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Battelle, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Flannery, Brendan" sort="Flannery, Brendan" uniqKey="Flannery B" first="Brendan" last="Flannery">Brendan Flannery</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Meyers, Adrienne F A" sort="Meyers, Adrienne F A" uniqKey="Meyers A" first="Adrienne F A" last="Meyers">Adrienne F A. Meyers</name><affiliation><nlm:affiliation>National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Medical Microbiology and Infectious Diseases, Winnipeg.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Department of Medical Microbiology, University of Nairobi, Kenya.</nlm:affiliation></affiliation></author><author><name sortKey="Luo, Ma" sort="Luo, Ma" uniqKey="Luo M" first="Ma" last="Luo">Ma Luo</name><affiliation><nlm:affiliation>National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg.</nlm:affiliation></affiliation></author><author><name sortKey="Bastien, Nathalie" sort="Bastien, Nathalie" uniqKey="Bastien N" first="Nathalie" last="Bastien">Nathalie Bastien</name><affiliation><nlm:affiliation>National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg.</nlm:affiliation></affiliation></author><author><name sortKey="Fowler, Robert A" sort="Fowler, Robert A" uniqKey="Fowler R" first="Robert A" last="Fowler">Robert A. Fowler</name><affiliation><nlm:affiliation>Sunnybrook Hospital, Department of Critical Care Medicine, University of Toronto, Toronto, Canada.</nlm:affiliation></affiliation></author><author><name sortKey="Katz, Jacqueline M" sort="Katz, Jacqueline M" uniqKey="Katz J" first="Jacqueline M" last="Katz">Jacqueline M. Katz</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Levine, Min Z" sort="Levine, Min Z" uniqKey="Levine M" first="Min Z" last="Levine">Min Z. Levine</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author><author><name sortKey="Kumar, Anand" sort="Kumar, Anand" uniqKey="Kumar A" first="Anand" last="Kumar">Anand Kumar</name><affiliation><nlm:affiliation>Section of Critical Care Medicine, Winnipeg.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Section of Infectious Diseases, University of Manitoba, Winnipeg.</nlm:affiliation></affiliation></author><author><name sortKey="Uyeki, Timothy M" sort="Uyeki, Timothy M" uniqKey="Uyeki T" first="Timothy M" last="Uyeki">Timothy M. Uyeki</name><affiliation><nlm:affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</nlm:affiliation></affiliation></author></analytic><series><title level="j">The Journal of infectious diseases</title><idno type="eISSN">1537-6613</idno><imprint><date when="2018" type="published">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Antibodies, Viral (blood)</term><term>Canada (epidemiology)</term><term>Critical Illness</term><term>Female</term><term>Humans</term><term>Influenza A Virus, H1N1 Subtype (immunology)</term><term>Influenza, Human (blood)</term><term>Influenza, Human (epidemiology)</term><term>Influenza, Human (mortality)</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Risk Factors</term><term>Seasons</term><term>Time Factors</term><term>Young Adult</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Antibodies, Viral</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Canada</term></keywords><keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Influenza A Virus, H1N1 Subtype</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Critical Illness</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Risk Factors</term><term>Seasons</term><term>Time Factors</term><term>Young Adult</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Background</b></p><p>The kinetics of the antibody response during severe influenza are not well documented.</p></div><div type="abstract" xml:lang="en"><p><b>Methods</b></p><p>Critically ill patients infected with 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09), confirmed by reverse-transcription polymerase chain reaction analysis or seroconversion (defined as a ≥4-fold rise in titers), during 2009-2011 in Canada were prospectively studied. Antibody titers in serially collected sera were determined using hemagglutinin inhibition (HAI) and microneutralization assays. Average antibody curves were estimated using linear mixed-effects models and compared by patient outcome, age, and corticosteroid treatment.</p></div><div type="abstract" xml:lang="en"><p><b>Results</b></p><p>Of 47 patients with A(H1N1)pdm09 virus infection (median age, 47 years), 59% had baseline HAI titers of <40, and 68% had baseline neutralizing titers of <40. Antibody titers rose quickly after symptom onset, and, by day 14, 83% of patients had HAI titers of ≥40, and 80% had neutralizing titers ≥40. Baseline HAI titers were significantly higher in patients who died compared with patients who survived; however, the antibody kinetics were similar by patient outcome and corticosteroid treatment. Geometric mean titers over time in older patients were lower than those in younger patients.</p></div><div type="abstract" xml:lang="en"><p><b>Conclusions</b></p><p>Critically ill patients with influenza A(H1N1)pdm09 virus infection had strong HAI and neutralizing antibody responses during their illness. Antibody kinetics differed by age but were not associated with patient outcome.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">29342251</PMID><DateCompleted><Year>2019</Year><Month>07</Month><Day>10</Day></DateCompleted><DateRevised><Year>2019</Year><Month>10</Month><Day>08</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1537-6613</ISSN><JournalIssue CitedMedium="Internet"><Volume>217</Volume><Issue>7</Issue><PubDate><Year>2018</Year><Month>03</Month><Day>13</Day></PubDate></JournalIssue><Title>The Journal of infectious diseases</Title><ISOAbbreviation>J. Infect. Dis.</ISOAbbreviation></Journal><ArticleTitle>Kinetics of Serological Responses in Critically Ill Patients Hospitalized With 2009 Pandemic Influenza A(H1N1) Virus Infection in Canada, 2009-2011.</ArticleTitle><Pagination><MedlinePgn>1078-1088</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1093/infdis/jiy013</ELocationID><Abstract><AbstractText Label="Background">The kinetics of the antibody response during severe influenza are not well documented.</AbstractText><AbstractText Label="Methods">Critically ill patients infected with 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09), confirmed by reverse-transcription polymerase chain reaction analysis or seroconversion (defined as a ≥4-fold rise in titers), during 2009-2011 in Canada were prospectively studied. Antibody titers in serially collected sera were determined using hemagglutinin inhibition (HAI) and microneutralization assays. Average antibody curves were estimated using linear mixed-effects models and compared by patient outcome, age, and corticosteroid treatment.</AbstractText><AbstractText Label="Results">Of 47 patients with A(H1N1)pdm09 virus infection (median age, 47 years), 59% had baseline HAI titers of <40, and 68% had baseline neutralizing titers of <40. Antibody titers rose quickly after symptom onset, and, by day 14, 83% of patients had HAI titers of ≥40, and 80% had neutralizing titers ≥40. Baseline HAI titers were significantly higher in patients who died compared with patients who survived; however, the antibody kinetics were similar by patient outcome and corticosteroid treatment. Geometric mean titers over time in older patients were lower than those in younger patients.</AbstractText><AbstractText Label="Conclusions">Critically ill patients with influenza A(H1N1)pdm09 virus infection had strong HAI and neutralizing antibody responses during their illness. Antibody kinetics differed by age but were not associated with patient outcome.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Rolfes</LastName><ForeName>Melissa A</ForeName><Initials>MA</Initials><AffiliationInfo><Affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gross</LastName><ForeName>F Liaini</ForeName><Initials>FL</Initials><AffiliationInfo><Affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Battelle, Atlanta, Georgia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Flannery</LastName><ForeName>Brendan</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Meyers</LastName><ForeName>Adrienne F A</ForeName><Initials>AFA</Initials><AffiliationInfo><Affiliation>National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Medical Microbiology and Infectious Diseases, Winnipeg.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Medical Microbiology, University of Nairobi, Kenya.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Luo</LastName><ForeName>Ma</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bastien</LastName><ForeName>Nathalie</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fowler</LastName><ForeName>Robert A</ForeName><Initials>RA</Initials><AffiliationInfo><Affiliation>Sunnybrook Hospital, Department of Critical Care Medicine, University of Toronto, Toronto, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Katz</LastName><ForeName>Jacqueline M</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Levine</LastName><ForeName>Min Z</ForeName><Initials>MZ</Initials><AffiliationInfo><Affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kumar</LastName><ForeName>Anand</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Section of Critical Care Medicine, Winnipeg.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Section of Infectious Diseases, University of Manitoba, Winnipeg.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Uyeki</LastName><ForeName>Timothy M</ForeName><Initials>TM</Initials><AffiliationInfo><Affiliation>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><CollectiveName>CSIS and ROSII Study Groups</CollectiveName></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>CC999999</GrantID><Agency>Intramural CDC HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Infect Dis</MedlineTA><NlmUniqueID>0413675</NlmUniqueID><ISSNLinking>0022-1899</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000914">Antibodies, Viral</NameOfSubstance></Chemical></ChemicalList><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000914" MajorTopicYN="N">Antibodies, Viral</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="Y">blood</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002170" MajorTopicYN="N" Type="Geographic">Canada</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016638" MajorTopicYN="Y">Critical Illness</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D053118" MajorTopicYN="N">Influenza A Virus, H1N1 Subtype</DescriptorName><QualifierName UI="Q000276" MajorTopicYN="Y">immunology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007251" MajorTopicYN="N">Influenza, Human</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="Y">blood</QualifierName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="Y">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012621" MajorTopicYN="N">Seasons</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013997" MajorTopicYN="N">Time Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName></MeshHeading></MeshHeadingList><InvestigatorList><Investigator ValidYN="Y"><LastName>Veguilla</LastName><ForeName>Vic</ForeName><Initials>V</Initials></Investigator><Investigator ValidYN="Y"><LastName>Division</LastName><ForeName>Influenza</ForeName><Initials>I</Initials></Investigator><Investigator ValidYN="Y"><LastName>Wood</LastName><ForeName>Gordon</ForeName><Initials>G</Initials></Investigator><Investigator ValidYN="Y"><LastName>Reynolds</LastName><ForeName>Steve</ForeName><Initials>S</Initials></Investigator><Investigator ValidYN="Y"><LastName>Dhingra</LastName><ForeName>Vinay</ForeName><Initials>V</Initials></Investigator><Investigator ValidYN="Y"><LastName>Winston</LastName><ForeName>Brent</ForeName><Initials>B</Initials></Investigator><Investigator ValidYN="Y"><LastName>Bagshaw</LastName><ForeName>Sean</ForeName><Initials>S</Initials></Investigator><Investigator ValidYN="Y"><LastName>Kutsogiannis</LastName><ForeName>Jim</ForeName><Initials>J</Initials></Investigator><Investigator ValidYN="Y"><LastName>Anderson</LastName><ForeName>William</ForeName><Initials>W</Initials></Investigator><Investigator ValidYN="Y"><LastName>Silverman</LastName><ForeName>Michael</ForeName><Initials>M</Initials></Investigator><Investigator ValidYN="Y"><LastName>Herridge</LastName><ForeName>Margaret</ForeName><Initials>M</Initials></Investigator><Investigator ValidYN="Y"><LastName>McGeer</LastName><ForeName>Alison</ForeName><Initials>A</Initials></Investigator><Investigator ValidYN="Y"><LastName>Aarts</LastName><ForeName>Mary-Anne</ForeName><Initials>MA</Initials></Investigator><Investigator ValidYN="Y"><LastName>Marshall</LastName><ForeName>John</ForeName><Initials>J</Initials></Investigator><Investigator ValidYN="Y"><LastName>Cook</LastName><ForeName>Deborah</ForeName><Initials>D</Initials></Investigator><Investigator ValidYN="Y"><LastName>McIntyre</LastName><ForeName>Lauralyn</ForeName><Initials>L</Initials></Investigator><Investigator ValidYN="Y"><LastName>Ahern</LastName><ForeName>Stephane</ForeName><Initials>S</Initials></Investigator><Investigator ValidYN="Y"><LastName>Khwaja</LastName><ForeName>Kosar</ForeName><Initials>K</Initials></Investigator><Investigator ValidYN="Y"><LastName>Bandrauk</LastName><ForeName>Natalie</ForeName><Initials>N</Initials></Investigator><Investigator ValidYN="Y"><LastName>Hall</LastName><ForeName>Richard</ForeName><Initials>R</Initials></Investigator><Investigator ValidYN="Y"><LastName>Rello</LastName><ForeName>Jordi</ForeName><Initials>J</Initials></Investigator></InvestigatorList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2017</Year><Month>09</Month><Day>06</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2018</Year><Month>01</Month><Day>11</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2018</Year><Month>1</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2019</Year><Month>7</Month><Day>11</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2018</Year><Month>1</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">29342251</ArticleId><ArticleId 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