Reduced Risk of Disease During Postsecondary Dengue Virus Infections
Reduced Risk of Disease During Postsecondary Dengue Virus Infections
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DOI：
10.1093/infdis/jit273
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发表时间：
2013-09-15
影响因子：
6.4
通讯作者：
Stoddard, Steven T.
中科院分区：
文献类型：
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作者：
Olkowski, Sandra;Forshey, Brett M.;Stoddard, Steven T.
背景由4种登革病毒（DENV）血清型（DENV-1-4）中的任何一种感染诱导的抗体可能会影响后续异源感染的临床结果。为了量化潜在的交叉保护作用，我们使用来自2006年9月至2011年2月在秘鲁伊基托斯进行的DENV-3和DENV-4传播期间的纵向研究的数据，估计疾病风险作为DENV感染的函数。通过用病毒中和试验分析系列血清样品来确定研究期间之前和期间的DENV感染。第三次和第四次感染被归类为继发感染。登革热病例是通过对急性发热性疾病的挨家挨户监测发现的。在易感参与者中，分别有39%（420/1077）和53%（1595/2997）血清转化为DENV-3和DENV-4。在7%的DENV-3感染和10%的DENV-4感染中检测到疾病。与原发性和继发性感染相比，DENV-3和DENV-4的继发性感染后疾病减少了93%和64%。尽管发病率较低，继发感染仍占明显感染的显著比例（14% [DENV-3感染]，45% [DENV-4感染]）。在本研究人群中，预先存在的异型抗体显著降低了疾病风险，但并未消除疾病风险。这些结果提高了对感染前病史如何与登革热结果和DENV传播动态相关的理解。
Background. Antibodies induced by infection with any 1 of 4 dengue virus (DENV) serotypes (DENV-1-4) may influence the clinical outcome of subsequent heterologous infections. To quantify potential cross-protective effects, we estimated disease risk as a function of DENV infection, using data from longitudinal studies performed from September 2006 through February 2011 in Iquitos, Peru, during periods of DENV-3 and DENV-4 transmission.Methods. DENV infections before and during the study period were determined by analysis of serial serum samples with virus neutralization tests. Third and fourth infections were classified as postsecondary infections. Dengue fever cases were detected by door-to-door surveillance for acute febrile illness.Results. Among susceptible participants, 39% (420/1077) and 53% (1595/2997) seroconverted to DENV-3 and DENV-4, respectively. Disease was detected in 7% of DENV-3 infections and 10% of DENV-4 infections. Disease during postsecondary infections was reduced by 93% for DENV-3 and 64% for DENV-4, compared with primary and secondary infections. Despite lower disease rates, postsecondary infections constituted a significant proportion of apparent infections (14% [for DENV-3 infections], 45% [for DENV-4 infections]).Conclusions. Preexisting heterotypic antibodies markedly reduced but did not eliminate the risk of disease in this study population. These results improve understanding of how preinfection history can be associated with dengue outcomes and DENV transmission dynamics.