Severity of seasonal influenza A epidemics is related to the antigenic novelty of the predominant viral strains circulating each year. Support for a strong correlation between epidemic severity and antigenic drift comes from infectious challenge experiments on vaccinated animals and human volunteers, field studies of vaccine efficacy, prospective studies of subjects with laboratory-confirmed prior infections, and analysis of the connection between drift and severity from surveillance data. We show that, given data on the antigenic and sequence novelty of the hemagglutinin protein of clinical isolates of H3N2 virus from a season along with the corresponding data from prior seasons, we can accurately predict the influenza severity for that season. This model therefore provides a framework for making projections of the severity of the upcoming season using assumptions based on viral isolates collected in the current season. Our results based on two independent data sets from the US and Hong Kong suggest that seasonal severity is largely determined by the novelty of the hemagglutinin protein although other factors, including mutations in other influenza genes, co-circulating pathogens and weather conditions, might also play a role. These results should be helpful for the control of seasonal influenza and have implications for improvement of influenza surveillance.
The hemagglutinin protein of influenza virus bears several sites of N-linked asparagine glycosylation. The number and location of these sites varies with strain and substrain. The human H3 hemagglutinin has gained several glycosylation sites on the antigenically important globular head since its introduction to humans, presumably due to selection. Although there is abundant evidence that glycosylation can affect antigenic and functional properties of the protein, direct evidence for selection is lacking. We have analyzed gain and loss of glycosylation sites on the side branches of a large phylogenetic tree of H3 HA1 sequences (branches off of the main, long-term line of descent). Side branches contrast with the main line of descent: losses of glycosylation sites are not uncommon, and they outnumber gains. Although other explanations are possible, this observation is consistent with weak selection for glycosylation sites or a more complicated pattern of selection. Furthermore, terminal and internal branches differ with respect to rates of gain and loss of glycosylation sites. This pattern would not be expected under selective neutrality, but is easily explained by weak selection or selection that changes with the immune state of the host population. Thus, it provides evidence that selection acts on the glycosylation state of hemagglutinin.