2009 A(H1N1) seroconversion rates and risk factors among the general population in Vientiane Capital, Laos

Abstract

Objective: To assess 2009 A(H1N1) seroconversion rates and their determinants within an unvaccinated population in Vientiane Capital, Laos.

Methods: CoPanFlu Laos, a general population cohort of 807 households and 4,072 participants was established in March 2010. Sociodemographic data, epidemiological data, and capillary blood samples were collected from all the household members in March, and again in October 2010, in order to assess the level of antibodies to 2009 A(H1N1) with the haemagglutination inhibition assay. 2009 A(H1N1) seroconversion was defined as a fourfold or greater increase in titre between inclusion and follow-up. Determinants for pandemic influenza infection were studied using the generalized estimating equations model, taking household clustering into account.

Results: Between March and November 2010, 3,524 paired sera were tested. Prior to the pandemic, our cohort was almost completely vaccine-naive for seasonal influenza. The overall seroconversion rate among nonvaccinated individuals (n = 2,810) was 14.3% (95%CI [13.0, 15.6]), with the highest rate for participants under 20 yo (19.8%, 95%CI [17.4, 22.4]) and the lowest rate for participants over 60 yo (6.5%, 95%CI [3.7, 10.4]). Participants with lower baseline titres had significantly higher infection rates, with a dose-effect relationship. Odds ratios (ORs) ranged from 76.5 (95%CI [27.1, 215.8]), for those with a titre at inclusion of 1∶10, to 8.1 (95%CI [3.3, 20.4]), for those with a titre of 1∶40. Having another household member with a titre ≥1∶80 was associated with a higher likelihood of immunity (OR = 3.3, 95%CI [2.8, 3.9]).

Conclusion: The determinants and age distribution for seroconversion within a vaccine-naive population were similar to those found in developed countries. This pandemic was characterized by strong epidemiological determinants, regardless of geographical zone and level of development. Moreover, we detected pre-existing cross-reacting antibodies in participants over 60 yo, which could not have originated from former multiple vaccination as has been suggested elsewhere.

Figure 1. Flowchart of inclusion and follow-up phases.

Figure 2. Seroprevalence, seroconversion rates and GMT in March and October 2010 in 2,810 nonvaccinated individuals.

Error bars represent confidence intervals. Spv: seroprevalence. Scr: seroconversion.≥1∶40: Seroprevalence analyzed with a cutoff≥1∶40.≥1∶80: Seroprevalence analyzed with a cutoff≥1∶80. p value calculated using the McNemar chi-square for seroprevalence matched pairs. p value calculated using the Wilcoxon signed rank test for GMT matched pairs.

Figure 3. Seasonal influenza-like illness activity and chronology of the pandemic events and CoPanFlu programme.

Figure 4. Distribution of samples at inclusion according to HI titre and age group.

p value calculated using the McNemar chi-square for matched pairs.

Figure 5. Seroconversion rates and GMT in March and October 2010 in 705 vaccinated participants.

Error bars represent confidence intervals. Spv: seroprevalence. Scr: seroconversion.≥1∶40: Seroprevalence analyzed with a cutoff≥1∶40.≥1∶80: Seroprevalence analyzed with a cutoff≥1∶80.