Near real-time data on the #human neutralizing #antibody #landscape to #influenza virus in summer of 2026 shows antigenic advance of #H3N2 subclade K region D mutants and #H1N1 D.3.1.1 Sa mutants

 

Abstract

Human seasonal influenza evolves rapidly, necessitating twice yearly decisions about whether to update the strains in the vaccine. To help inform this decision, we have been using high-throughput sequencing-based neutralization assays to make twice yearly measurements of how recent human sera neutralize current human H3N2 and H1N1 strains. Here we provide the third installment in this series of measurements by reporting 47,851 titers representing neutralization of 148 viral strains by 325 human sera collected between April and August of 2026. Our measurements show that new H3N2 subclade K strains with mutations in antigenic region D and new H1N1 subclade D.3.1.1 strains with mutations in antigenic region Sa (such as G155E) have reduced neutralization by human sera, with notable heterogeneity in the impact of some of these mutations across sera from different individuals. This paper is accompanied by an interactive summary (https://jbloomlab.github.io/flu-seqneut-2026/summary.html) that enables detailed exploration of the results, and all titer data are publicly available for further analysis to aid vaccine antigen selection and studies of viral evolution.

Competing Interest Statement

JDB consults for Pfizer, GSK, Apriori Bio, and Merck. JDB has received stock options in the Vaccine Company. JDB is an inventor on Fred Hutch licensed patents related to techniques to characterize the antigenic effects of viral variation. SEH is a co-inventor on patents that describe the use of nucleoside-modified mRNA as a vaccine platform. SEH reports receiving consulting fees from Sanofi, Pfizer, Lumen, Novavax, and Merck. ALG reports contract testing to UW from Abbott, Cepheid, Novavax, Pfizer, Janssen, Assembly Biosciences, Aicuris, Innovative Molecules, and Hologic, research support from Gilead, personal consulting fees from Arisan Therapeutics, outside of the described work. JAE reports support to her institution from GSK, Pfizer, Moderna, and is a consultant for GSK, Pfizer, Merck, Meissa vaccines, Moderna, and Shionogi. ST reports research funding from Pfizer for a separate study.

Funder Information Declared

National Institute of Allergy and Infectious Diseases, R01AI165821, F30AI186284, 75N93021C00015

Howard Hughes Medical Institute, https://ror.org/006w34k90

Source: 

Link: https://doi.org/10.64898/2026.09.15.751855

____

#Taiwan, Seasonal #Influenza and #COVID19 #Epidemics Weekly #Update (CDC, September 15 '26): #H1N1pdm09 flu virus & #SARS-CoV-2 PQ.16.1.1 predominated

 

{Excerpts}

(...)

    The CDC pointed out that the domestic influenza epidemic is rising and in its epidemic season. 

    In the 36th week (September 6th-12th), there were 136,796 outpatient and emergency room visits for influenza-like illnesses, an increase of 16.5% compared to the previous week. 

    Additionally, last week (September 8th-14th), there were 92 new cases of severe influenza complications (79 H1N1, 5 H3N2, and 8 untyped A cases) and 21 deaths (18 H1N1, 2 H3N2, and 1 untyped A case). 

    Laboratory monitoring data shows that the influenza virus currently circulating in the community is mainly type A, with type A H1N1 accounting for 82.2%. 

    This flu season has seen a cumulative total of 1,421 severe cases (800 H1N1, 503 H3N2, 28 untyped type A, and 90 type B) and 274 deaths (149 H1N1, 104 H3N2, 9 untyped type A, and 12 type B). 

    The majority of severe cases are among those aged 65 and above (65.0%) and those with a history of chronic diseases (82.7%). 68.3% of those affected have not received the flu vaccine this season.

    According to data from the Taiwan Centers for Disease Control (CDC), the COVID-19 epidemic in Taiwan is declining, but it is still in its epidemic period. 

    In week 36 (September 6-12), there were 17,847 outpatient and emergency room visits related to COVID-19, a 13.3% decrease compared to the previous week (August 30-September 5). 

    Last week (September 8-14), there were 53 new severe cases and 18 local deaths. 

    Since October 2025, there have been a cumulative total of 675 locally transmitted cases of COVID-19 complicated by severe illness, of which 124 have died. 

    Severe cases are predominantly among those aged 65 and above (73.3%) and those with a history of chronic diseases (82.8%). 83.6% of these cases have not received the COVID-19 vaccine this season. 

    In the past four weeks, the most prevalent local variants have been NB.1.8.1 and PQ.16.1.1.

(...)

Source: 

Link: https://www.cdc.gov.tw/Bulletin/Detail/CqW5UAMFqpDkwJWfWG-WGw?typeid=9

____

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Emergence and spread of NA-I223V and NA-S247N double-mutant #H1N1pdm09 #influenza viruses with reduced #oseltamivir susceptibility in the #Netherlands and beyond, 2023 to 2026

 

Abstract

In 2023/24, A(H1N1)pdm09 influenza viruses with neuraminidase (NA)-S247N emerged in NA-clade C.5.3.3 carrying NA-I223V, spread internationally, then faded. Such double mutants reappeared sporadically in 2024/25. They expanded again in 2025/26 in NA-clade D.3 viruses carrying NA-S247N after acquiring NA-I223V in Europe – notably Spain, the Netherlands, Finland and France, and beyond. Dutch double mutants from both seasons showed median 12- and 13-fold reduced inhibition by oseltamivir. These findings underscore the need for ongoing genomic and phenotypic monitoring of antiviral susceptibility.

© Creative Commons License. This work is licensed under a Creative Commons Attribution 4.0 International License.

Source: 

Link: https://doi.org/10.2807/1560-7917.ES.2026.31.36.2600733

____

Updated #H1N1pdm09 #influenza virus #ferret infection #model permits refined #antiviral #assessment using aerosol inhalation challenge

 

Abstract

Seasonal influenza viruses continue to pose a significant threat to human health. As influenza viruses exhibit sustained genetic drift, it is imperative that animal studies utilize challenge strains that reflect contemporary, currently circulating viruses when evaluating pathogenicity, viral tropism, transmissibility, and antiviral sensitivity to better inform public health responses. Ferrets are considered the gold-standard small animal model for assessing currently circulating influenza viruses. Seasonal influenza A(H1N1)pdm09 viruses replicate well in both the upper and lower respiratory tract of ferrets, providing an important model for developing improved vaccination and therapeutic strategies; however, many of these studies have relied on a 2009 virus isolate. Utilising representative influenza A(H1N1)pdm09 virus strains from 2009 to 2022, we explored virus replication kinetics and lung pathogenesis in ferrets following intranasal inoculation with these contemporary strains. Our results revealed strain specific differences, with greater lung viral loads and pathogenesis following inoculation with A/Sydney/5/2021 compared to other strains. Efficient transmissibility of A/Sydney/5/2021 virus to naïve recipients was also observed following both contact and airborne exposure to infected donor ferrets. To refine this updated model, we performed side-by-side evaluation of oseltamivir antiviral efficacy following traditional intranasal or aerosol inhalation influenza challenges. Pre-treatment with oseltamivir demonstrated greater reductions in viral shedding from the upper respiratory tract than post-infection treatment of ferrets infected by aerosol inhalation, while the intranasal route showed reduced oseltamivir efficacy independent of the timing of antiviral treatment. These findings provide the basis for using an updated A(H1N1)pdm09 challenge virus for ferret studies as an alternative to the commonly used, but now less relevant 2009 early pandemic viruses. It also highlights how different methods of virus inoculation can influence outcomes of ferret antiviral studies, with an aerosol challenge model able to demonstrate differences between therapeutic and prophylactic treatments, which were not apparent with an intranasal challenge model.

Source: 

Link: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1014604

____

#Risk factors for #hospital admission and #mortality in patients with #influenza virus #infection: a systematic review and meta-analysis

 

Summary

Background

Identifying risk factors associated with hospital admission and mortality in patients with influenza is crucial for guiding clinical management and public health strategies. To support an update of WHO influenza clinical guidelines, this systematic review and meta-analysis assessed risk factors for hospital admission and all-cause mortality in patients with seasonal influenza.

Methods

We systematically searched Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Global Health for observational studies published from Jan 1, 2000, until Oct 30, 2025, that enrolled patients of any age with laboratory-confirmed seasonal influenza and reported an adjusted effect estimate for the association between at least one risk factor and hospital admission or all-cause mortality, or both. We conducted inverse-variance random-effects model meta-analyses to summarise the evidence and assessed the certainty of evidence using the GRADE approach. We registered the protocol with PROSPERO, CRD42024535669.

Findings

We identified 35 808 records, of which 63 studies enrolling 2 150 518 participants (mean age 3·6–87·9 years) were eligible. In patients with non-severe influenza, evidence with moderate or high certainty showed that older age (odds ratio 1·72 per 10-year increase for adults [95% CI 1·02–2·89]); cardiovascular disease (2·72 [1·24–5·94]); HIV, immunodeficiency, or immunosuppression (2·70 [1·55–4·70]); chronic respiratory disease (2·24 [1·90–2·64]); and any neurological disease (2·31 [1·65–3·24]) were major risk factors for hospital admission—pregnancy (1·88 [1·73–2·05]), diabetes (1·84 [1·26–2·67]), and malignancy (1·75 [1·12–2·75]) were additional risk factors for hospital admission. In patients with severe influenza, evidence with moderate or high certainty showed that secondary bacterial infection (4·13 [1·53–11·14]), malnutrition (3·29 [1·57–6·89]), sepsis (3·19 [2·08–4·89]), acute kidney injury (2·92 [1·11–7·73]), age 65 years or older (2·47 [2·21–2·75]), chronic cardiovascular disease (2·43 [1·16–5·09]), malignancy (2·21 [1·31–3·72]), and chronic neurological disease (2·08 [1·13–3·83]) were major risk factors for all-cause mortality—any liver disease (1·86 [1·35–2·58]); HIV, immunodeficiency, or immunosuppression (1·79 [1·51–2·13]), and chronic obstructive pulmonary disease (1·74 [1·37–2·20]) were additional risk factors for all-cause mortality.

Interpretation

Age 65 years or older, immunocompromised status, cardiovascular disease, neurological disease, and chronic respiratory disease are major risk factors for hospital admission in patients with non-severe seasonal influenza. Secondary bacterial infection, malnutrition, sepsis, acute kidney injury, age 65 years or older, chronic cardiovascular disease, malignancy, and chronic neurological disease are major risk factors for all-cause mortality in patients with severe seasonal influenza. Our findings support risk stratification and targeted prevention and treatment strategies for seasonal influenza.

Funding

WHO.

Source: 

Link: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00195-5/abstract?rss=yes

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#Taiwan, Seasonal #Influenza and #COVID19 Epidemics Weekly #Update (CDC, September 8 '26): H1N1pdm09 flu virus & SARS-CoV-2 PQ.16.1.1 variant are predominant

 

{Excerpts}

(...)

    The CDC pointed out that in week 35 (August 30th - September 5th), there were 115,136 outpatient and emergency room visits for influenza-like illnesses, an increase of 11.0% from the previous week, showing a recent upward trend. 

    The percentage of emergency room visits reached 11.2%, exceeding the epidemic threshold (11.0%), indicating the start of the epidemic period. 

    Additionally, last week (September 1st - September 7th), there were 105 new cases of severe influenza complications (97 H1N1, 4 H3N2, 4 untyped A cases) and 19 deaths (18 H1N1, 1 untyped A case). 

    Laboratory monitoring data shows that the influenza virus currently circulating in the community is mainly type A, with type A H1N1 accounting for 79.4% of the cases. 

    This flu season (2023-2024) has seen a cumulative total of 1,329 severe cases (717 H1N1, 498 H3N2, 24 untyped type A, and 90 type B) and 253 deaths (131 H1N1, 102 H3N2, 8 untyped type A, and 12 type B). 

    The majority of severe cases are among those aged 65 and above (65.1%) and those with a history of chronic diseases (82.8%). 68.6% of those affected have not received the flu vaccine this season.

    According to data from the Taiwan Centers for Disease Control (CDC), the COVID-19 epidemic in Taiwan is declining, but it is still in its epidemic period. 

    In week 35 (August 30 - September 5), there were 20,199 outpatient and emergency room visits related to COVID-19, a 9.7% decrease compared to the previous week (August 23 - August 29). 

    Last week (September 1 - September 7), there were 73 new severe cases and 15 deaths. 

    Since October 2025, there have been a cumulative total of 622 locally transmitted cases of COVID-19 complicated by severe illness, of which 106 have died. 

    The majority of severe cases are among those aged 65 and above (72.7%) and those with a history of chronic diseases (83.0%). 84.9% of these cases have not received the COVID-19 vaccine this season. 

    In the past four weeks, the predominant variant strain in locally transmitted cases has been PQ.16.1.1.

(...)

Source: 

Link: https://www.cdc.gov.tw/Bulletin/Detail/5gJTj70wu9L3psY5kQLUuA?typeid=9

____

#Influenza and Other Respiratory Viruses Research #References (AMEDEO, Sept. 5 '26)

 

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Immunogenicity and #safety of seasonal #influenza #vaccine co-administered with other vaccines: a systematic review and meta-analysis

 

Abstract

Seasonal influenza remains a leading cause of global morbidity and mortality, highlighting the need for vaccination strategies that improve coverage and streamline vaccine delivery. In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCTs), cohort, case-control, and cross-sectional studies, evaluating immunogenicity and safety of same-day co-administration of influenza vaccines with COVID-19 or other vaccines, compared with non-concomitant administration. Comparators included sequential administration, single vaccine administration or placebo-controlled delayed vaccination. Risk of bias was evaluated using the Cochrane Risk-of-Bias tool for Randomized Trials and Risk of Bias In Non-randomized Studies of Interventions; certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation. Immunogenicity was assessed using geometric mean fold rise (GMFR) in antibody titres and seroprotection rate. Safety was assessed by adverse event (AE) incidence. 52 eligible studies were included. Influenza immunogenicity was comparable between the co-administration and non-concomitant comparator group across all strains (H1N1 GMFR ratio of means (ROM): 1.02 [95% CI: 0.95–1.10]; H3N2, 1.05 [95% CI: 0.97–1.13]; B strain, 1.01 [95% CI: 0.97–1.05]). Pooled risk ratio (RR) for seroprotection was 1.00 for all three strains with 95% CIs ranging from 0.99–1.01. GMFR for COVID-19 vaccines was modestly reduced under co-administration (ROM 0.84 [95% CI: 0.74–0.95]; p = 0.006). Serious AEs were more frequent in the co-administration group compared to the non-concomitant group (RR 1.41 [95% CI: 1.07–1.86]; p = 0.014; absolute risk difference: 1.56 percentage points). Overall, co-administration preserves influenza immunogenicity but modestly reduces COVID-19 vaccine GMFR. Although safety findings warrant cautious interpretation, the low absolute risk difference supports its feasibility as a strategy to streamline vaccination schedules and improve uptake.

Source: 

Link: https://www.nature.com/articles/s41541-026-01548-z

____

#Report on #influenza viruses received and tested by the #Melbourne #WHO Collaborating Centre for Reference and Research on Influenza during 2025

 

Abstract

As part of its role in the World Health Organization (WHO) Global Influenza Surveillance and Response System (GISRS), the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne (the Centre) received 13,817 human influenza-positive samples during 2025. Viruses were analysed for their antigenic, genetic, and antiviral susceptibility properties. Selected viruses were propagated in qualified cells or embryonated hens’ eggs for potential use in seasonal influenza virus vaccines. Of the 13,817 samples received or processed, influenza A(H1N1)pdm09 viruses predominated, accounting for 46.1% of samples, compared to 21.2% for A(H3N2) viruses and 19.5% for influenza B viruses; one influenza C virus was received. Among viruses analysed at the Centre, the majority of A(H1N1)pdm09 (> 99%) and influenza B (98%) viruses were antigenically similar to their respective WHO recommended vaccine strains for the Southern Hemisphere in 2025. In contrast, only 43% of A(H3N2) viruses were antigenically similar to their respective WHO recommended vaccine strains. Of 3,307 samples tested for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir, 37 A(H1N1)pdm09 viruses showed highly reduced inhibition by oseltamivir and no influenza viruses tested showed highly reduced inhibition by zanamivir. Of 5,080 samples with sequencing of the polymerase acidic (PA) gene, no genetic markers associated with highly reduced susceptibility to baloxavir marboxil were identified.

Source: 

Link: https://ojs.cdi.cdc.gov.au/index.php/cdi/article/view/3489

____

#Taiwan, Seasonal #Influenza and #COVID19 Epidemics Situation #Update (CDC, September 1 '26): #H1N1pdm09 flu virus and PQ.16.1.1 SARS-CoV variant are predominant

 

{Excerpt}

(...)

    The CDC pointed out that in the 34th week (August 23-29), there were 101,628 outpatient and emergency room visits for influenza-like illnesses, an increase of 5.6% compared to the previous week, showing a recent slow upward trend. 

    In addition, last week (August 25-31), there were 85 new cases of severe influenza complications (80 H1N1, 3 H3N2, and 2 untyped A cases) and 14 deaths (12 H1N1, 1 H3N2, and 1 untyped A case). 

    Laboratory monitoring data shows that the influenza virus currently circulating in the community is mainly type A, with type A H1N1 accounting for 74.1% of the cases. 

    This flu season (2023-2024) has seen a cumulative total of 1,224 severe cases (620 H1N1, 494 H3N2, 20 untyped type A, and 90 type B) and 234 deaths (113 H1N1, 102 H3N2, 7 untyped type A, and 12 type B). 

    The majority of severe cases are among those aged 65 and above (64.6%) and those with a history of chronic diseases (82.8%). 69.4% of those affected have not received the flu vaccine this season.

    According to data from the Taiwan Centers for Disease Control (CDC), the COVID-19 epidemic in Taiwan is declining, but it remains at a plateau. 

    In the 34th week (August 23-29), there were 21,969 outpatient and emergency room visits related to COVID-19, a 13.4% decrease compared to the previous week (August 16-22). 

    Last week (August 25-31), there were 69 new locally transmitted severe cases and 18 local deaths. 

    Since October 2025, there have been a cumulative total of 549 locally transmitted cases of COVID-19 complicated by severe illness, of which 91 have died. 

    The majority of severe cases are among those aged 65 and above (72.5%) and those with a history of chronic diseases (83.1%). 85.1% of these cases have not received the COVID-19 vaccine this season. 

    In the past four weeks, the predominant variant strain in locally transmitted cases has been PQ.16.1.1.

(...)

Source: 

Link: https://www.cdc.gov.tw/Bulletin/Detail/GWRkQ03fZuKKWwdv191UyQ?typeid=9

____

#Antibody profiles across #H5N1 and previously circulating viruses are highly dynamic and #age- and imprint- independent

 

Abstract

The increasing incidence of H5N1 influenza virus transmission from animal species to humans has heightened concerns about an imminent H5N1 pandemic. Prior studies using recombinant hemagglutinin and neuraminidase proteins have reported age-dependent cross-reactivity to H5N1, attributed to immune imprinting from an individual's first influenza virus exposure. However, whether this pattern holds when using whole inactivated virus (WIV), capturing antibodies against diverse viral proteins, and is stable over time remains unknown. We therefore aimed to determine whether H5N1 cross-reactivity of pre-existing antibodies to whole virus follows an age-dependent or imprinting-specific pattern, and whether this pattern is stable over a five-year period. To this end, we measured serum antibody levels in adolescents, adults and seniors by ELISA using whole inactivated H5N1 virus as antigen rather than purified proteins. Detectable, albeit generally low, levels of H5N1-reactive antibodies were present in most individuals, irrespective of age. Comparison of antibody levels against H5N1 with those to five historical influenza virus strains revealed a consistent positive correlation between H5N1-reactive antibodies and responses to the H1N1pdm09 strain A/California/7/2009 (CA), across all age groups. Using unbiased clustering of antibody titers against H5N1, CA, and the H3N2 strain A/Perth/16/2009 (PE), we identified seven distinct age-transcending antibody profiles. These profiles covered individuals with varying titers to all three included viruses but also identified individuals with high anti-CA levels, yet low anti-H5N1 levels and vice versa. Moreover, despite stable antibody levels over a five-year interval in the study population, individual antibody levels and profiles fluctuated considerably over this period. Taken together, our results confirm the presence of H5N1-reactive antibodies in human sera and their association with previously circulating strains. However, they also caution against inferring antibody levels against a new strain based solely on responses to antigenically related strains and highlight the limitations of extrapolating immune status from single timepoint measurements.

Competing Interest Statement

The authors have declared no competing interest.

Source: 

Link: https://www.medrxiv.org/content/10.64898/2026.08.26.26361396v1

____

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