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  • Viral variants that arise in the global influenza population begin as de novo mutations in single infected hosts, but the evolutionary dynamics that transform within-host variation to global genetic diversity are poorly understood. Here, we demonstrate that influenza evolution within infected humans recapitulates many evolutionary dynamics observed at the global scale. We deep-sequence longitudinal samples from four immunocompromised patients with long-term H3N2 influenza infections. We find parallel evolution across three scales: within individual patients, in different patients in our study, and in the global influenza population. In hemagglutinin, a small set of mutations arises independently in multiple patients. These same mutations emerge repeatedly within single patients and compete with one another, providing a vivid clinical example of clonal interference. Many of these recurrent within-host mutations also reach a high global frequency in the decade following the patient infections. Our results demonstrate surprising concordance in evolutionary dynamics across multiple spatiotemporal scales. DOI: http://dx.doi.org/10.7554/eLife.26875.001
subject
  • Influenza
  • Hematology
  • Vaccine-preventable diseases
  • Evolutionary dynamics
  • Animal viral diseases
  • Evolutionary biology
  • Healthcare-associated infections
  • RTT
  • RTTEM
  • Subtypes of Influenza A virus
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