An Insular Outbreak of Dengue Hemorrhagic Fever

Pk, Russell; Tm, Yuill; Nisalak, A; Udomsakdi, Suchinda; Dj, Gould; Pe, Winter

doi:10.4269/ajtmh.1968.17.600

Cited by 52 publications

(19 citation statements)

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“…As in all other prospective studies, all hospitalized dengue cases experienced secondary dengue infections. [5][6][7][16][17][18] It was surprising to discover in the cohort population that 31 children experienced infections in the sequence DEN 1 followed by DEN 2, but these yielded no hospitalizations. If the ratio observed in Rayong, Thailand is applied to Yogyakarta, six DSS cases (or approximately 15 DHF/DSS cases) would have been expected to occur with the number of observed secondary dengue infections in the sequence DEN 2 followed by DEN 1.…”

Section: Discussionmentioning

confidence: 99%

“…Prior to 1980, prospective studies of dengue calculated dengue infection rates using hemagglutination-inhibition (HI) tests. [16][17][18] This leads to two problems: 1) with the passage of time, an unknown fraction of HI antibodies degrade below test detection threshold and 2) these tests are unable to distinguish monotypic from multitypic immune individuals. Therefore, HI antibodies overestimate primary infections and underestimate secondary infections, and each impacts on estimates of the ratio of hospitalized cases to secondary dengue infections.…”

Section: Discussionmentioning

confidence: 99%

“…The percentage of hospitalized patients with secondary dengue infections is at the high end of the 0.5-3.6% range measured in previous studies. [5][6][7][16][17][18] The lower of these calculations (0.5%) were made in Thailand and Myanmar and counted only DSS cases. It is possible that discrepancies in comparative rates of DHF/DSS among secondary dengue infections could be due to more stringent diagnostic criteria applied in Thailand and Myanmar than in Indonesia.…”

Section: Discussionmentioning

confidence: 99%

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

Graham¹,

Juffrie²,

Tan³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

183

125

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Graham¹,

Juffrie²,

Tan³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

183

125

View full text Add to dashboard Cite

show abstract

“…40,41 Thus, it has been suggested that a specific genotype of DENV-2 may have the propensity to cause DHF, whereas other genotypes are associated with the less severe DF. [42][43][44][45][46][47][48] Several reports examined differences between DENV-2 American versus Asian strains, and attempted to explain why the American DENV-2 genotype strains lack the properties necessary to cause severe disease in a secondary heterotypic infection. Results of these studies support the hypothesis that specific structural differences between the Southeast Asian and American genotypes may be involved in disease pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

Variation in Inflammatory/Regulatory Cytokines in Secondary, Tertiary, and Quaternary Challenges with Dengue Virus

Sierra

Pérez²,

Álvarez³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. Secondary heterologous dengue infection is a risk factor for severe disease manifestations because of the immune-enhancement phenomenon. Succeeding clinical infections are seldom reported, and the clinical course of tertiary and quaternary dengue infections is not clear. Cuba represents a unique environment to study tertiary/quaternary dengue infections in a population with known clinical and serologic dengue markers and no dengue endemicity. We took advantage of this exceptional epidemiologic condition to study the effect of primary, secondary, tertiary, and quaternary dengue infection exposure on the expression of pro-inflammatory and regulatory cytokines, critical in dengue infection pathogenesis, by using a dengue infection ex vivo model. Whereas secondary exposure induced a high cytokine response, we found a significantly lower expression of tumor necrosis factor-α, interferon-γ, interleukin-10, and tumor growth factor-β after tertiary and quaternary infectious challenge. Significant differences in expression of the cytokines were seen between the dengue immune profiles, suggesting that the sequence in which the immune system encounters serotypes may be important in determining the nature of the immune response to subsequent infections.

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“…The most favored is called the two-infections phenomenon, and it is supported by evidence that the risk of developing a DHF is higher in patients exposed in the past to different serotypes of dengue. 9,10 This is believed to be the consequence of a nonneutralizing antibody-dependant infection enhancement. 11 Other factors have been identified to be associated with DHF, such as the virulence of the dengue virus strain and host genetic factors like human leucocyte antigen (HLA) type.…”

Section: Introductionmentioning

confidence: 99%

Contribution of Dengue Fever to the Burden of Acute Febrile Illnesses in Papua New Guinea: An Age-Specific Prospective Study

Senn¹,

Luang-Suarkia²,

Manong³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Malaria is a major contributor to the burden of febrile illnesses in Papua New Guinea (PNG). Dengue fever (DF) is likely to contribute; however, its epidemiology in PNG is poorly understood. We performed a prospective age-stratified study in outpatient clinics investigating the prevalence of DF; 578 patients were enrolled, and 317 patients with a negative rapid diagnostic test (RDT) for malaria were tested for dengue. Malaria was confirmed in 52% (301/578, 95% confidence interval [CI] = 48–56%), DF was diagnosed in 8% (46/578, 95% CI = 6–10%), and 40% (95% CI = 36–44%) had neither diagnosis. Among the 317 malaria RDT-negative patients, 14% (45/317, 95% CI = 10–18%) had DF. The seroprevalence of dengue immunoglobulin G (IgG) was 83% (204/247, 95% CI = 78–87%), and no dengue hemorrhagic fever was seen. This study provides good evidence for the first time that DF is common in PNG and is responsible for 8% of fever episodes. The common occurrence of DF in a population with presumed previous exposure to dengue is an important observation.

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An Insular Outbreak of Dengue Hemorrhagic Fever

Cited by 52 publications

References 0 publications

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

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

Variation in Inflammatory/Regulatory Cytokines in Secondary, Tertiary, and Quaternary Challenges with Dengue Virus

Contribution of Dengue Fever to the Burden of Acute Febrile Illnesses in Papua New Guinea: An Age-Specific Prospective Study

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