Sangkawibha N, Rojanasuphot S, Ahandrik S, Viriyapongse S, Jatanasen S, Salitul V, Phanthumachinda B, Halstead S B
Am J Epidemiol. 1984 Nov;120(5):653-69. doi: 10.1093/oxfordjournals.aje.a113932.
In January 1980, the municipal area of Rayong, Thailand, and contiguous suburban villages were chosen for a long-term study on dengue epidemiology. From 3,185 children randomly sampled in schools and households, the population prevalence of neutralizing antibody to the four dengue serotypes was estimated. To estimate the incidence of infection with each dengue virus serotype (dengue seroconversions), first grade children were re-bled in January 1981 (cohort study). Children admitted to hospital were studied for dengue virus isolation and antibody responses in paired sera. An epidemic of dengue occurred in 1980. Plaque reduction neutralization tests of 1,009 pre-epidemic sera from children aged less than 1-10 years of age determined that 3.3% were immune to dengue 1, 13.2% to dengue 2, 6.4% to dengue 3, and 5.8% to dengue 4. Examination of pre- and post-epidemic cohort blood samples revealed that the incidence of dengue infection in 251 seronegative children was 39.4% (15.1% dengue 1, 11.1% dengue 2, 2.0% dengue 3, 4.8% dengue 4, and 6.4% two or more dengue viruses). Among the 52,935 residents of the study area, there were 22 cases of virologically and clinically confirmed dengue shock syndrome, in children 15 years or younger. All 22 shock syndrome cases had secondary type antibody responses. Eight of 22 had been included in the random serologic sample prior to onset of shock; five had been immune to dengue 1, two to dengue 3, one to dengue 4, and none to dengue 2. Despite the high rate of dengue 1 infections in 1980, only dengue 2 viruses were recovered from dengue shock syndrome cases, including two dengue 1 immune children with pre-illness serum specimens. Although the pre-epidemic prevalence of antibodies to dengue 1 was the lowest to any type, children with this immunologic background contributed disproportionately to shock cases. In descending order of magnitude, risk factors for dengue shock syndrome in Rayong were secondary infections with dengue 2 which followed primary infections with dengue 1, dengue 3, or dengue 4.
1980年1月，泰国罗勇府市区及相邻的郊区村庄被选来进行一项关于登革热流行病学的长期研究。从学校和家庭中随机抽取的3185名儿童中，估算了针对四种登革热血清型的中和抗体的人群流行率。为了估算每种登革热病毒血清型的感染发病率（登革热血清转化），一年级儿童于1981年1月再次采血（队列研究）。对住院儿童进行了登革热病毒分离研究以及配对血清中的抗体反应研究。1980年发生了一次登革热流行。对1009份来自1至10岁儿童的流行前血清进行蚀斑减少中和试验，结果显示3.3%的儿童对登革热1型免疫，13.2%对登革热2型免疫，6.4%对登革热3型免疫，5.8%对登革热4型免疫。对流行前和流行后的队列血样进行检测发现，251名血清阴性儿童中登革热感染发病率为39.4%（登革热1型为15.1%，登革热2型为11.1%，登革热3型为2.0%，登革热4型为4.8%，两种或更多种登革热病毒为6.4%）。在研究区域的52935名居民中，有22例15岁及以下儿童的登革热休克综合征经病毒学和临床确诊。所有22例休克综合征病例均有继发性抗体反应。22例中有8例在休克发作前已被纳入随机血清学样本；5例对登革热1型免疫，2例对登革热3型免疫，1例对登革热4型免疫，对登革热2型均无免疫。尽管1980年登革热1型感染率很高，但从登革热休克综合征病例中仅分离出登革热2型病毒，包括两名在发病前有血清标本的对登革热1型免疫的儿童。尽管流行前针对登革热1型的抗体流行率是所有血清型中最低的，但具有这种免疫背景的儿童在休克病例中所占比例却过高。按重要性降序排列，罗勇府登革热休克综合征的危险因素依次为：在感染登革热1型、3型或4型之后继发感染登革热2型。
