Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, USA; United States Public Health Service, Silver Springs, MD, USA.
Institute for Global Health and Translational Sciences and Department of Medicine, and Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA; Department of Virology, Armed Forces Research Institute for Medical Sciences, Bangkok, Thailand.
Lancet Infect Dis. 2022 Feb;22(2):e42-e51. doi: 10.1016/S1473-3099(20)30871-9. Epub 2021 Jul 12.
The most severe consequences of dengue virus infection include shock, haemorrhage, and major organ failure; however, the frequency of these manifestations varies, and the relative contribution of pre-existing anti-dengue virus antibodies, virus characteristics, and host factors (including age and comorbidities) are not well understood. Reliable characterisation of the epidemiology of severe dengue first depends on the use of consistent definitions of disease severity. As vaccine trials have shown, severe dengue is a crucial interventional endpoint, yet the infrequency of its occurrence necessitates the inclusion of thousands of study participants to appropriately compare its frequency among participants who have and have not been vaccinated. Hospital admission is frequently used as a proxy for severe dengue; however, lack of specificity and variability in clinical practices limit the reliability of this approach. Although previous infection with a dengue virus is the best characterised risk factor for developing severe dengue, the influence of the timing between dengue virus infections and the sequence of dengue virus infections on disease severity is only beginning to be elucidated. To improve our understanding of the diverse factors that shape the clinical spectrum of disease resulting from dengue virus infection, prospective, community-based and clinic-based immunological, virological, genetic, and clinical studies across a range of ages and geographical regions are needed.
登革病毒感染最严重的后果包括休克、出血和主要器官衰竭；然而，这些表现的频率不同，预先存在的抗登革病毒抗体、病毒特性和宿主因素（包括年龄和合并症）的相对贡献尚不清楚。可靠地表征重症登革热的流行病学首先取决于使用一致的疾病严重程度定义。正如疫苗试验所示，重症登革热是一个关键的干预终点，但由于其发生频率较低，需要纳入数千名研究参与者，以便在接种和未接种疫苗的参与者中适当比较其发生频率。住院治疗通常被用作重症登革热的替代指标；然而，临床实践中缺乏特异性和可变性限制了这种方法的可靠性。虽然先前感染登革病毒是发生重症登革热的最佳特征风险因素，但登革病毒感染之间的时间间隔以及登革病毒感染的顺序对疾病严重程度的影响才刚刚开始阐明。为了更好地了解塑造登革病毒感染导致的疾病临床谱的各种因素，需要在不同年龄和地理区域开展前瞻性、基于社区和基于诊所的免疫学、病毒学、遗传学和临床研究。
