Unlike influenza A, influenza B virus lacks a broad animal reservoir and, with it, the pandemic potential that makes influenza A a constant global security concern. But the absence of pandemic risk has never equated to clinical irrelevance. Influenza B virus drives substantial morbidity in seasonal epidemics, and its two historically circulating lineages, B/Victoria and B/Yamagata, have followed strikingly different trajectories in recent years. Surveillance has documented no confirmed naturally circulating B/Yamagata-lineage viruses since March 2020, a development widely linked to the intense non-pharmaceutical interventions of the COVID-19 pandemic era. Current influenza B activity is now overwhelmingly attributable to B/Victoria-lineage viruses, a shift with real consequences for vaccine composition and the interpretation of vaccine effectiveness studies.

The central premise of the review is that the host genome may help explain a persistent puzzle: why individuals exposed to the same virus, and receiving the same vaccine, experience markedly different outcomes. Variation in genes governing antigen presentation, innate viral sensing, interferon signaling, and host dependency or restriction factors could plausibly generate heterogeneity in susceptibility, disease severity, cross-lineage immunity, and responsiveness to immunization. This framework draws on decades of immunogenetic research in influenza A and in broader antiviral biology, but the authors stress a crucial caveat: much of what has been proposed for influenza B rests on inference rather than on direct, influenza B virus-specific human data.

At the heart of the immunogenetic hypothesis lies the human leukocyte antigen system, the protein complex responsible for presenting viral peptide fragments to T cells. Differences in HLA alleles can alter which viral epitopes are displayed, how strongly T cells respond, and consequently how efficiently an infected or vaccinated individual clears virus or mounts protective memory. For influenza A, associations between specific HLA variants and outcomes such as infection risk, severity, and antibody titers after vaccination have been reported across multiple populations. Extending these findings to influenza B is not straightforward, however, because the two virus types differ in their evolutionary dynamics, transmission patterns, and the antigenic landscape they present to the immune system. Epitope repertoires are not interchangeable, and a genetic variant that enhances clearance of one influenza type may have little or no measurable effect on the other.

Beyond antigen presentation, the review considers the innate immune machinery that first detects invading influenza viruses. Pattern recognition receptors such as the toll-like receptors and RIG-I-like receptors sense viral RNA and trigger signaling cascades that culminate in interferon production. Genetic polymorphisms in these sensors and in the downstream interferon pathway can modulate the vigor of the early antiviral response, potentially determining whether an infection is contained quickly or gains a foothold. Similarly, host dependency factors that the virus requires for entry, replication, and assembly, along with restriction factors that actively inhibit viral replication, represent additional layers where inherited variation could shape susceptibility. Each of these domains offers a plausible mechanistic route by which host genotype could influence influenza B outcomes, yet the authors find that direct evidence in the influenza B context remains sparse and fragmentary.

When it comes to vaccine response, the review is similarly measured. The best-supported determinants of influenza vaccine performance, the authors conclude, are not genetic at all. Antigenic match between vaccine strains and circulating viruses, the continuous process of antigenic drift that erodes that match over time, the age of the vaccinee, prior exposure history, and baseline immunity stand out as the factors with the strongest evidentiary grounding. These non-genetic determinants have been repeatedly validated across seasons and populations, and they explain a considerable portion of the year-to-year variability in vaccine effectiveness. Genetic predictors specific to influenza B, by contrast, remain incompletely defined, and no validated host-genetic biomarker currently exists to guide vaccination decisions for this virus.

This asymmetry between well-established extrinsic factors and poorly characterized intrinsic ones is not merely an academic gap. Predictive models of influenza B immune control and vaccine performance are limited by the absence of genotype-linked outcome data. Without large, well-phenotyped cohorts in which host genotype, immune phenotyping, and lineage-resolved virologic outcomes are collected together, the field cannot distinguish genuine genetic effects from confounding by age, prior exposure, or antigenic distance. The authors argue that such integrated studies represent the most important priority for future research, and they outline a research agenda built around linking these data streams in a single analytical framework.

The disappearance of the B/Yamagata lineage adds an unusual wrinkle to this agenda. With no naturally circulating Yamagata viruses detected for years, vaccine components targeting that lineage have become biologically obsolete, and regulatory and advisory bodies have been reconsidering the composition of seasonal vaccines, including the transition from quadrivalent to trivalent formulations. For immunogenetic studies, the loss of a circulating lineage complicates the interpretation of historical cross-lineage immunity data and underscores the need for lineage-resolved outcome measures in future cohorts. Any genetic association study conducted today will, in practice, be measuring responses against B/Victoria viruses, and generalizing those findings to influenza B as a whole carries inherent uncertainty.

Population-specific variation presents another challenge. Immunogenetic associations identified in one ancestry or geographic setting frequently fail to replicate elsewhere, reflecting both genuine differences in allele frequencies and differences in study design, exposure patterns, and co-circulating pathogens. The international composition of the review team, spanning institutions in China, Pakistan, and Uzbekistan, reflects a growing recognition that influenza B research must extend beyond the settings where it has traditionally been studied. Building the evidence base for immunogenetic determinants will require multi-center collaborations with standardized genotyping platforms, harmonized immune phenotyping protocols, and consistent definitions of susceptibility, severity, and vaccine response.

The review, which received support from the Guangdong Basic and Applied Basic Research Foundation and the Dongguan Science and Technology of Social Development Program, ultimately delivers a message of disciplined optimism. The biological logic connecting host genetic variation to influenza B outcomes is sound, and the methodological tools needed to test it, from affordable genome sequencing to sophisticated immune profiling, are now widely available. What is missing is the concerted, influenza B-specific data collection that would convert plausible mechanisms into clinically actionable knowledge. Until that work is done, antigenic match, age, and exposure history will remain the most reliable predictors of how influenza B behaves in populations, while the genome’s contribution waits to be quantified.

Subject of Research: Immunogenetic determinants of influenza B virus susceptibility and vaccine response

Article Title: Immunogenetic determinants of influenza B virus susceptibility and vaccine response: current evidence, gaps, and future directions

Article References: Din, G. U., Khan, H., Tariq, Z., Zhao, J., Khan, A., Eshboev, F., Xu, G., Hu, Y., & Huang, K. (2026). Immunogenetic determinants of influenza B virus susceptibility and vaccine response: current evidence, gaps, and future directions. Virology Journal. https://doi.org/10.1186/s12985-026-03292-1

Image Credits: AI Generated

DOI: 10.1186/s12985-026-03292-1

Keywords: influenza B virus, immunogenetics, host susceptibility, vaccine response, immune heterogeneity, antigenic drift, HLA, interferon, B/Victoria lineage, B/Yamagata lineage, Immunogenetic, determinants