Sustainable Sciences Institute, Managua 14006, Nicaragua.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
Sci Transl Med. 2024 May 29;16(749):eadn2199. doi: 10.1126/scitranslmed.adn2199.
Infection with any of the four dengue virus serotypes (DENV1-4) can protect against or enhance subsequent dengue depending on preexisting antibodies and infecting serotype. Additionally, primary infection with the related flavivirus Zika virus (ZIKV) is associated with increased risk of DENV2 disease. Here, we measured how prior DENV and ZIKV immunity influenced risk of disease caused by DENV1-4 in a pediatric Nicaraguan cohort. Of 3412 participants in 2022, 10.6% experienced dengue cases caused by DENV1 ( = 139), DENV4 ( = 133), DENV3 ( = 54), DENV2 ( = 9), or an undetermined serotype ( = 39). Longitudinal clinical and serological data were used to define infection histories, and generalized linear and additive models adjusted for age, sex, time since last infection, and year, and repeat measurements were used to predict disease risk. Compared with flavivirus-naïve participants, primary ZIKV infection was associated with increased risk of disease caused by DENV4 (relative risk = 2.62, 95% confidence interval: 1.48 to 4.63) and DENV3 (2.90, 1.34 to 6.27), but not DENV1 infection. Primary DENV infection or DENV followed by ZIKV infection was also associated with increased risk of DENV4 disease. We reanalyzed 19 years of cohort data and demonstrated that prior flavivirus immunity and antibody titer had distinct associations with disease risk depending on incoming serotype. We thus find that prior ZIKV infection, like prior DENV infection, is associated with increased risk of disease with certain DENV serotypes. Cross-reactivity among flaviviruses should be considered when assessing vaccine safety and efficacy.
感染四种登革热病毒血清型(DENV1-4)中的任何一种都可能对随后的登革热起到保护作用或增强其作用,具体取决于预先存在的抗体和感染的血清型。此外,感染相关的黄病毒寨卡病毒(ZIKV)与 DENV2 疾病的发病风险增加有关。在这里,我们测量了先前的 DENV 和 ZIKV 免疫如何影响尼加拉瓜儿科队列中由 DENV1-4 引起的疾病风险。在 2022 年的 3412 名参与者中,10.6%(=139)经历了由 DENV1、DENV4(=133)、DENV3(=54)、DENV2(=9)或未确定血清型(=39)引起的登革热病例。使用纵向临床和血清学数据来定义感染史,并使用广义线性和加法模型进行调整,以适应年龄、性别、上次感染后的时间以及年份,并且使用重复测量来预测疾病风险。与黄病毒无感染史的参与者相比,原发性 ZIKV 感染与 DENV4(相对风险=2.62,95%置信区间:1.48 至 4.63)和 DENV3(2.90,1.34 至 6.27)疾病的发病风险增加有关,但与 DENV1 感染无关。初次 DENV 感染或 DENV 继之以 ZIKV 感染也与 DENV4 疾病的发病风险增加有关。我们重新分析了 19 年的队列数据,并表明先前的黄病毒免疫和抗体滴度与疾病风险具有不同的关联,具体取决于传入的血清型。因此,我们发现与先前的 DENV 感染一样,先前的 ZIKV 感染与某些 DENV 血清型的疾病风险增加有关。在评估疫苗安全性和有效性时,应考虑黄病毒之间的交叉反应性。