A shorter time interval between first and second dengue infections is associated with protection from clinical Illness in a school-based cohort in Thailand

Kathryn B. Anderson, Robert V. Gibbons, Derek A T Cummings, Ananda Nisalak, Sharone Green, Daniel H. Libraty, Richard G. Jarman, Anon Srikiatkhachorn, Mammen P. Mammen, Buddhari Darunee, In Kyu Yoon, Timothy P. Endy

Research output: Contribution to journalArticle

Abstract

Background. Despite the strong association between secondary dengue virus (DENV) infections and dengue hemorrhagic fever (DHF), the majority of secondary infections are subclinical or mild. The determinants of clinical severity remain unclear, though studies indicate a titer-dependent and time-dependent role of cross-protective anti-DENV antibodies.Methods. Data from 2 sequential prospective cohort studies were analyzed for subclinical and symptomatic DENV infections in schoolchildren in Kamphaeng Phet, Thailand (1998-2002 and 2004-2007). Children experiencing ≥1 DENV infection were selected as the population for analysis (contributing 2169 person-years of follow-up).Results. In total, 1696 children had ≥1 DENV infection detected during their enrollment; 268 experienced 2 or more infections. A shorter time interval between infections was associated with subclinical infection in children seronegative for DENV at enrollment, for whom a second-detected DENV infection is more likely to reflect a true second infection (average of 2.6 years between infections for DHF, 1.9 for DF, and 1.6 for subclinical infections).Conclusions. These findings support a pathogenesis model where cross-reactive antibodies wane from higher-titer, protective levels to lower-titer, detrimental levels. This is one of the first studies of human subjects to suggest a window of cross-protection following DENV infection since Sabin's challenge studies in the 1940s.

Original languageEnglish (US)
Pages (from-to)360-368
Number of pages9
JournalJournal of Infectious Diseases
Volume209
Issue number3
DOIs
StatePublished - 2014

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Keywords

  • antibodies
  • dengue
  • epidemiology
  • immunity
  • pathogenesis
  • prospective cohort study

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Allergy

Cite this

Anderson, K. B., Gibbons, R. V., Cummings, D. A. T., Nisalak, A., Green, S., Libraty, D. H., Jarman, R. G., Srikiatkhachorn, A., Mammen, M. P., Darunee, B., Yoon, I. K., & Endy, T. P. (2014). A shorter time interval between first and second dengue infections is associated with protection from clinical Illness in a school-based cohort in Thailand. Journal of Infectious Diseases, 209(3), 360-368. https://doi.org/10.1093/infdis/jit436