Reinfections and Cross-Protection in the 1918/19 Influenza Pandemic: Revisiting a Survey Among Male and Female Factory Workers.

The COVID-19 pandemic highlights questions regarding reinfections and immunity resulting from vaccination and/or previous illness. Studies addressing related questions for historical pandemics are limited. We revisit an unnoticed archival source on the 1918/19 influenza pandemic. We analysed individual responses to a medical survey completed by an entire factory workforce in Western Switzerland in 1919. Among the total of = 820 factory workers, 50.2% reported influenza-related illness during the pandemic, the majority of whom reported severe illness. Among male workers 47.4% reported an illness vs. 58.5% of female workers, although this might be explained by varied age distribution for each sex (median age was 31 years old for men, vs. 22 years old for females). Among those who reported illness, 15.3% reported reinfections. Reinfection rates increased across the three pandemic waves. The majority of subsequent infections were reported to be as severe as the first infection, if not more. Illness during the first wave, in the summer of 1918, was associated with a 35.9% (95%CI, 15.7-51.1) protective effect against reinfections during later waves. Our study draws attention to a forgotten constant between multi-wave pandemics triggered by respiratory viruses: Reinfection and cross-protection have been and continue to be a key topic for health authorities and physicians in pandemics, becoming increasingly important as the number of waves increases.