Sequential dengue virus infections detected in active and passive surveillance programs in Thailand, 1994–2010

Abstract

BackgroundThe effect of prior dengue virus (DENV) exposure on subsequent heterologous infection can be beneficial or detrimental depending on many factors including timing of infection. We sought to evaluate this effect by examining a large database of DENV infections captured by both active and passive surveillance encompassing a wide clinical spectrum of disease.MethodsWe evaluated datasets from 17 years of hospital-based passive surveillance and nine years of cohort studies, including clinical and subclinical DENV infections, to assess the outcomes of sequential heterologous infections. Chi square or Fisher’s exact test was used to compare proportions of infection outcomes such as disease severity; ANOVA was used for continuous variables. Multivariate logistic regression was used to assess risk factors for infection outcomes.ResultsOf 38,740 DENV infections, two or more infections were detected in 502 individuals; 14 had three infections. The mean ages at the time of the first and second detected infections were 7.6 ± 3.0 and 11.2 ± 3.0 years. The shortest time between sequential infections was 66 days. A longer time interval between sequential infections was associated with dengue hemorrhagic fever (DHF) in the second detected infection (OR 1.3, 95% CI 1.2-1.4). All possible sequential serotype pairs were observed among 201 subjects with DHF at the second detected infection, except DENV-4 followed by DENV-3. Among DENV infections detected in cohort subjects by active study surveillance and subsequent non-study hospital-based passive surveillance, hospitalization at the first detected infection increased the likelihood of hospitalization at the second detected infection.ConclusionsIncreasing time between sequential DENV infections was associated with greater severity of the second detected infection, supporting the role of heterotypic immunity in both protection and enhancement. Hospitalization was positively associated between the first and second detected infections, suggesting a possible predisposition in some individuals to more severe dengue disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1590-z) contains supplementary material, which is available to authorized users.

Drivers of Inter-individual Variation in Dengue Viral Load Dynamics

“…Despite limitations in our current understanding of dengue pathogenesis, key risk factors for the development of severe dengue disease have been identified in longitudinal epidemiological studies [10–13]. These studies have shown that the most important risk factor for severe disease manifestation is a secondary heterologous dengue infection [10].…”

Análisis de la evidencia sobre eficacia y seguridad de la vacuna de dengue CYD-TDV y su potencial registro e implementación en el Programa de Vacunación Universal de México

“…[21][22][23][24] Ante el riesgo incrementado de hospitalización por casos de dengue virológicamente confirmado en el grupo de vacunados en niños de nueve años o menores, los periodos de seguimiento posteriores a la aplicación de la vacuna deben extenderse.…”

“…Como describe el reciente reporte del Comité Asesor de Seguridad en Vacunas de la Organización Mundial de la Salud (OMS), 24 es imperativo contar con más evidencia sobre el papel de la serología negativa a dengue al momento de vacunar, asociado con este riesgo, con esta vacuna o con cualquier otro candidato futuro.…”

Polytopic vaccination with a live-attenuated dengue vaccine enhances B-cell and T-cell activation, but not neutralizing antibodies

“…There are four antigenically distinct DENV serotypes, DENV1-4. Infection with one DENV serotype typically induces lifelong protection against homotypic infection and temporary protection against heterotypic infections [2]. Clinical presentation of DENV infection varies from asymptomatic infection to a non-specific febrile illness (Dengue fever, DF) and the more severe dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS).…”