The term “original antigenic sin”(OAS) was first used in the 1960s to describe how one’s first exposure to influenza virus shapes the outcome of subsequent exposures to antigenically related strains. In the decades that have passed, OAS-like responses have been shown to play an integral role in both protection from and susceptibility to infections. OAS may also have an important deterministic role in the differential efficacy of influenza vaccine responses observed for various age cohorts across seasons. In this article, we review how the understanding of OAS has progressed from its initial description and highlight important outstanding questions in need of further study.