BackgroundInfluenza virus A(H1N1)pdm09 first appeared in Israel in late April 2009, disappeared in midâMarch 2010, and reappeared in late October 2010. Symptoms were mostly mild without need for medical care.ObjectivesTo provide targets for future pandemic preparedness and response by evaluating the dynamics and cumulative incidence of A(H1N1)pdm09 infection, the virusâspecific seroprevalence (HI antibody titer >1:40) at the height of the pandemic, during its decline and thereafter.MethodsA crossâsectional seroepidemiological study was conducted on 6911 serum samples collected before, during, and after the pandemic.ResultsCumulative incidence of infection derived from the differences between postâ and preâpandemic seroprevalence was 54·1%, 32·9%, 22·9%, 14·8%, and 6·3% in ageâgroups 0â9, 10â19, 20â49, 50â79, and â„80 years, respectively, and 28·5% for all ageâgroups combined. Vaccination could have contributed at the most 4·6% to the postâpandemic population seroprevalence. High preâpandemic immune response (47·4%) found in a cohort aged 15â18 year was strongly associated with birth years 1990â1993. Morbidity began to decline in midâNovember 2009 at 32·8% population seroprevalence (45% in ages 0â19 year) and stopped in March 2010 at 43·4% population seroprevalence in February 2010 (70% in ages 0â19 year). Between February and September 2010, seroprevalence declined by 12·2% allowing virus recirculation from October 2010.ConclusionsOur study provides targets for controlling future influenza pandemics in Israel. Vaccination should focus on the younger ageâgroups (0â19 year) which played a key role in transmission of the A(H1N1)pdm09 due to lack of background immunity (ages 0â9 year) and high exposure rates (ages 10â19 year).