Assessment of Hemagglutinin Sequence Heterogeneity during Influenza Virus Transmission in Families

To examine the molecular epidemiology of influenza virus transmission, the nucleotide sequences of the HA1 domain of the hemagglutinin (HA) gene of 57 influenza A and 24 influenza B viruses recovered in a single season were analyzed. No nucleotide sequence differences were found among the 10 viruses that were recovered twice from the same patient. The nucleotide sequences of influenza A viruses were identical within each family but varied among the 14 families included in the study. The sequences of influenza A viruses recovered from 18 residents of the same community showed that 83% of the viruses differed from the others by at least 1 nucleotide residue. These findings indicate that most cases of influenza in households in which 1 family member has been infected are the result of secondary transmission from the index patient and not of acquisition from other community sources. Substantial genetic conservation during virus transmission within households is indicated.