Background: Many influenza studies assume that symptomatic and asymptomatic cases have equivalent antibody responses.
Methods: This study examines the relationship between influenza symptoms and serological response. Influenza-positive index cases and household members in Managua, Nicaragua, during 2012-2017 were categorized by symptom status.
Results: Antibody response was assessed using hemagglutination inhibition assays (HAI). Among 510 cases, 74.5% had ≥4-fold increase in HAI antibodies, and 75.3% had febrile illness. In a logistic regression model, febrile cases had 2.17 times higher odds of a ≥4-fold titer rise compared to asymptomatic cases (95% confidence interval, 1.02-4.64).
Conclusions: Studies relying on serological assays may not generalize to asymptomatic infections.
Keywords: antibodies; hemagglutination inhibition tests; infectious disease transmission; influenza A virus; signs and symptoms.
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