“…Therefore, diagnosis of WNV infection has predominantly occurred for individuals with no preexisting flavivirus antibody. However, in the tropical Americas (Central America, South America, and the Caribbean), individuals are likely to have been repeatedly exposed to multiple enzootic flaviviruses, including the dengue viruses (dengue virus type 1 [DENV-1] to DENV-4), SLEV, Ilheus virus, T'Ho virus, and yellow fever virus (8,12,13,15,27,29,32,33,43). This not only complicates diagnosis but suggests the possibility of cross-protection or, conversely, antibody-dependent enhancement (ADE) of the immune response, thus modulating the course of disease (34).…”