Dynamics of naturally acquired antibody against Haemophilus influenzae type a capsular polysaccharide in a Canadian Aboriginal population

• Frequent natural exposure to Hia is required to maintain protective immunity.
• Epigenetic factors may affect formation of natural immunity in Aboriginal people.
• Further data pertaining to immunological correlates of Hia are needed.
• Modeling can inform timelines of boosting immunity and vaccination policies.

Severe infections caused by Haemophilus influenzae type a (Hia) have reached alarming rates in some Canadian Aboriginal communities. We sought to estimate the frequency of exposure to this pathogen and timelines for boosting protective antibodies.We developed a model of secondary antigenic challenge (natural exposure), and used data for anti-Hia antibodies in serum samples of healthy and immunocompromised adults in a population of Northwestern Ontario, Canada. We parameterized the model with available estimates from previous studies for the decay rate of antibody and its protective levels against both Hia carriage and invasive disease. Simulations were initialized using antibody concentrations from data. We investigated both the duration of immunity without secondary antigenic challenge and the average time between subsequent exposures to Hia.When there was no new natural exposure, serum antibody concentrations in healthy Aboriginal individuals decreased below the level (1 μg/ml) assumed for protection against invasive Hia disease 3 years after primary exposure. This period was shorter (about 2 years) for Aboriginal individuals suffering from chronic renal failure. We estimated that a new antigenic challenge occurs once in 5 and 2 years for healthy and immunocompromised Aboriginal individuals, respectively. More frequent natural exposure was required to maintain protective antibody levels for non-Aboriginal individuals compared to Aboriginal individuals.The findings suggest that frequent boosting of natural immunity is required to maintain the anti-Hia antibody levels protecting against invasive Hia disease, particularly in individuals with underlying medical conditions. This information has important implications for immunization when an anti-Hia vaccine becomes available.