A prospective seroepidemiologic study on dengue in children four to nine years of age in Yogyakarta, Indonesia I. studies in 1995-1996.

Abstract

Abstract. A prospective study on dengue (DEN) viruses was initiated in October 1995 in Gondokusuman kecamatan, Yogyakarta, Indonesia. This report presents data from the first year of the study. The studied cohort included all children 4-9 years of age living in the kecamatan. Blood samples for serology were collected from 1,837 children in October 1995 and again in October 1996. Blood samples for virus isolation and serology were collected from cohort children who were seen in municipal health clinics with febrile syndromes or admitted to hospitals with a provisional diagnosis of dengue hemorrhagic fever. Dengue serotype antibody prevalence and 1995-1996 infection rates were calculated using a single dilution (1:60) 70% plaque reduction endpoint neutralization test. Prevalence of dengue antibody at the beginning of the study was DEN 1 ϭ 12%, DEN 2 ϭ 16%, DEN 3 ϭ 2%, DEN 4 ϭ 4%, and two or more dengue infections ϭ 22%. Total dengue antibody prevalence increased from 38% in 4-year-old children to 69% in 9-year-old children. During the observation period, primary dengue infection rates were DEN 1 ϭ 4.8%, DEN 2 ϭ 7.7%, DEN 3 ϭ 4.2%, and DEN 4 ϭ 3.4%, while two or more dengue infections occurred in 6.7% of the study population. The secondary dengue infection rate was 19.0%. From febrile cases, all four dengue viruses were isolated with DEN 3 predominating. Seven children were hospitalized, including one fatal case with a hospital diagnosis of dengue shock syndrome. Based upon presence of antibody in the initial cohort bleeding and the serologic response both weeks and several months following illness, all had secondary dengue infections. Neutralizing antibody patterns in the initial cohort bleeding and in late convalescent serum samples permitted recognition of dengue infection sequence in five patients: DEN 2-DEN 1 (3), DEN 2-DEN 4 (1), DEN 1-DEN 3 (1), and none in the sequence DEN 1-DEN 2. In the total cohort 6.5% of the observed secondary infections were of the sequence DEN 2-DEN 1, while 4.9% were DEN 1-DEN 2, a highly pathogenic sequence in previous studies. Reduced pathogenic expression of secondary DEN 2 with enhanced pathogenic expression of secondary DEN 1 infections was an unexpected finding. Further studies will be required to understand the respective contributions to pathogenicity of antibody from initial dengue infections versus the biological attributes of the second infecting dengue viruses.The dengue (DEN) viruses (serotypes 1, 2, 3, and 4) are transmitted in nearly all tropical countries with a total population at risk in excess of 2.5 billion people.

Correlation of disease spectrum among four Dengue serotypes: a five years hospital based study from India

“…The hyperendemicity with co-circulation of two or more serotypes during the same time period have been widely suspected as one of the major cause of disease severity in South East Asia. 8,21 Various studies are trying to establish connection between causative serotype and disease outcome. Few of which propose that Den-2 and Den-3 may cause more severe disease, 8,[22][23][24] however, a defi nite link between distinct serotypes and severe manifestations has not been established yet.…”

Timing of CD8+ T Cell Responses in Relation to Commencement of Capillary Leakage in Children with Dengue

“…The characteristics of this patient population are described in Table II. At enrollment, the median illness day was 4 d (range [1][2][3][4][5][6] and the median number of days prior to defervescence 2 d (range, 26 to 0). Among the 390 patients with laboratory confirmed dengue, there were 62 (16%) patients (41 with DHF and 21 with DF) with blood samples that were ever positive with the pooled NS3 133-142 -specific tetramers.…”

“…Viral traits as well as host genetic and physiological factors may each contribute to the clinical phenotype (2)(3)(4). In children and adults, epidemiological evidence suggests that two sequential dengue virus (DENV) infections, with the second infection caused by a different DENV serotype to the first, is associated with elevated risk (but is not an absolute requirement) for DHF (5)(6)(7)(8). Infants born to dengue immune mothers can also develop DHF as a result of primary infection (9,10).…”

É possível identificar a dengue em crianças a partir do critério de caso suspeito preconizado pelo Ministério da Saúde?

“…Cases with positive IgM for a single sample would be probable dengue cases since the finding can persist for up to 90 days. Despite this, probable and confirmed cases have been analyzed in conjunction in some studies 14,26,27 and the Health Ministry defines confirmed cases of dengue as those in which IgM is positive in association with indicative clinical and epidemiological status. 3 According to that definition, around 50% of the children with acute nonspecific febrile diseases had dengue.…”