Risk factors for influenza infection in vaccinated racehorses: lessons from an outbreak in Newmarket, UK in 2003.

Between March and May 2003, clinical equine influenza was confirmed among vaccinated racehorses in Newmarket, UK. A particular feature was that 2-year-old horses were apparently less susceptible than older animals. Statistical analyses comparing infected and non-infected animals showed the unusual, apparently counter-intuitive inverse age effect was principally explained by more recent vaccination among younger animals, despite broadly equivalent antibody levels between age groups. There was novel evidence for sexual dimorphism in susceptibility to infection and data supported the hypothesis that vaccination at a young age in the presence of maternally derived antibody has detrimental long-term effects on protective immunity. The practice of blanket vaccination soon after initial diagnosis ('vaccinating in the face of the outbreak') was apparently supported as a method of control. Data suggested that protective immunity conveyed by aluminium hydroxide-only adjuvanted vaccine was sub-optimal compared to other vaccine preparations.