Multiple contributory factors to the age distribution of disease cases: a modeling study in the context of influenza A(H3N2v).

BACKGROUND In late 2011 and early 2012, 13 cases of human influenza resulted from infection with a novel triple reassortant swine-origin influenza virus, influenza A (H3N2) variant. This variant was notable for its inclusion of the matrix gene from the 2009 influenza A(H1N1) pandemic virus. While most of these confirmed cases were among children, the transmission potential and likely age-dependent susceptibility to the virus was unknown. Preliminary serologic studies indicated that very young children have less protection than older children and adults. METHODS We construct a mathematical transmission model of influenza transmission that allows for external zoonotic exposure to infection and show how exposure and susceptibility-related factors contribute to the observed case distribution. RESULTS AND CONCLUSIONS Age-dependent susceptibility to infection strongly influences epidemic dynamics. The result is that the risk of an outbreak in a highly susceptible age group may be substantially higher than in an older age group with less susceptibility, but exposure-related factors must also be accounted for when interpreting case data.