Study Highlights• Establish a prospective, longitudinal adult cohort investigating influenza vaccination and infection in Wellington, New Zealand • Analysis of an adult cohort representative of community rates of influenza infection and vaccination • Define unique and co-regulated baseline cellular correlates of protection and susceptibility to symptomatic influenza infection in vaccinated and unvaccinated adults • Define unique pre-infection cellular components associated with asymptomatic and symptomatic influenza illness • Multivariate predictive and regression modeling of symptomatic influenza risk considering demographics, serologic factors, vaccine status, and immune cell populations Main Takeaways • Pre-infection peripheral cell profiles is a stronger predictor of symptomatic influenza susceptibility than vaccination, demographics, or serology by univariate analysis and multivariate partition and regression models • Distinct baseline cell profiles underlie susceptibility and protection from symptomatic influenza in vaccinated and unvaccinated adults • Protection from symptomatic influenza correlates with increased individual frequencies of diverse and polyfunctional influenza-specific CD4 and CD8 T cells, cells associated with engagement of humoral responses including cTfh and mDCs, and B cell-recruiting Th17 cells, and innate effector CD16 + cytotoxic and cytokine-producing NK cells • Susceptibility to symptomatic influenza correlates with increased individual frequencies of antigen-agnostic activated CD16 neg NK cells and inflammatory γδ T cells, and TNFα single-producing CD8 T cells • Multivariate regression modeling identified reduced risk of symptomatic influenza infection associated with naive, CD107a, and Th17 CD4 T cells, while increased risk associated with anti-IBV(Yam) HAI titers, CD8 TNFα