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Background: There is limited information about the role of different agegroups, particularly subgroups of school-age children and younger adults inpropagating influenza epidemics.  Methods: For a communicable disease outbreak, some subpopulations may play adisproportionate role during the ascent of the outbreak due to increasedsusceptibility and/or contact rates. Such subpopulations can be identified byconsidering the proportion that cases in a subpopulation represent among allcases in the population occurring before the epidemic peak (Bp), thecorresponding proportion after the epidemic peak (Ap), to calculate therelative risk for a subpopulation, RR=Bp/Ap. We estimated RR for several agegroups using data on reported influenza A cases in Germany between 2002-2017.  Results: Children aged 14-17y had the highest RR estimates for 7 out of 15influenza A epidemics in the data, including the 2009 pandemic, and the large2016/17, 2008/09, and 2006/07 seasons. Children aged 10-13y had the highest RRestimates during 3 epidemics, including the large 2014/15 and 2004/05 seasons.Children aged 6-9y had the highest RR estimates during two epidemics, includingthe large 2012/13 season. Children aged 2-5y had the highest RR estimate duringthe moderate 2015/16 season; adults aged 18-24y had the highest RR estimateduring the small 2005/06 season; adults aged 25-34y had the highest RR estimateduring the large, 2002/03 season.  Conclusions: Our results support the prominent role of all school-agechildren, particularly the oldest ones, in propagating influenza epidemics inthe community. We note that national vaccination coverage levels among olderschool-age children were lower than among younger school-age children duringthe recent influenza seasons in the US, and influenza vaccination program inEngland has not been phased in yet for secondary school students.

On the relative role of different age groups during influenza A epidemics in Germany, 2002-2017