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

Anton Camacho, Sébastien Ballesteros, Andrea Linn Graham, Fabrice Carrat, Oliver Ratmann, Bernard Cazelles

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35 Scopus citations


Influenza usually spreads through the human population in multiple-wave outbreaks. Successive reinfection of individuals over a short time interval has been explicitly reported during past pandemics. However, the causes of rapid reinfection and the role of reinfection in driving multiple-wave outbreaks remain poorly understood. To investigate these issues, we focus on a two-wave influenza A/H3N2 epidemic that occurred on the remote island of Tristan da Cunha in 1971. Over 59 days, 273 (96%) of 284 islanders experienced at least one attack and 92 (32%) experienced two attacks. We formulate six mathematical models invoking a variety of antigenic and immunological reinfection mechanisms. Using a maximum-likelihood analysis to confront model predictions with the reported incidence time series, we demonstrate that only two mechanisms can be retained: some hosts with either a delayed or deficient humoral immune response to the primary influenza infection were reinfected by the same strain, thus initiating the second epidemic wave. Both mechanisms are supported by previous empirical studies and may arise from a combination of genetic and ecological causes.We advocate that a better understanding and account of heterogeneity in the human immune response are essential to analysis of multiple-wave influenza outbreaks and pandemic planning.

Original languageEnglish (US)
Pages (from-to)3635-3643
Number of pages9
JournalProceedings of the Royal Society B: Biological Sciences
Issue number1725
StatePublished - 2011

All Science Journal Classification (ASJC) codes

  • General Immunology and Microbiology
  • General Environmental Science
  • General Biochemistry, Genetics and Molecular Biology
  • General Agricultural and Biological Sciences


  • Host immune response
  • Influenza pandemic
  • Model selection
  • Reinfection
  • State-space models


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