Abstract
BackgroundInfants born to dengue immune mothers acquire maternal antibodies to dengue. These antibodies, though initially protective, decline during the first year of life to levels thought to be disease enhancing, before reaching undetectable levels. Infants have long been studied to understand the interaction between infection and disease on an individual level.Methods/FindingsConsidering infants (cases <1 year old) as a unique group, we analyzed serotype specific dengue case data from patients admitted to a pediatric hospital in Bangkok, Thailand. We show differences in the propensity of serotypes to cause disease in individuals with dengue antibodies (infants and post-primary cases) and in individuals without dengue antibodies (primary cases). The mean age of infant cases differed among serotypes, consistent with previously observed differential waning of maternal antibody titers by serotype. We show that trends over time in epidemiology of infant cases are consistent with those observed in the whole population, and therefore with trends in the force of infection.Conclusions/SignificanceInfants with dengue are informative about the interaction between antibody and the dengue serotypes, confirming that in this population DENV-2 and DENV-4 almost exclusively cause disease in the presence of dengue antibody despite infections occurring in others. We also observe differences between the serotypes in the mean age in infant cases, informative about the interaction between waning immunity and disease for the different serotypes in infants. In addition, we show that the mean age of infant cases over time is informative about transmission in the whole population. Therefore, ongoing surveillance for dengue in infants could provide useful insights into dengue epidemiology, particularly after the introduction of a dengue vaccine targeting adults and older children.
Highlights
DENV is a flavivirus that exists as four serotypes
We show that trends over time in epidemiology of infant cases are consistent with those observed in the whole population, and with trends in the force of infection
Infants with dengue are informative about the interaction between antibody and the dengue serotypes, confirming that in this population DENV-2 and DENV-4 almost exclusively cause disease in the presence of dengue antibody despite infections occurring in others
Summary
DENV is a flavivirus that exists as four serotypes. Infection with one serotype leads to longterm immunity to that serotype. There is a short-term period of cross-protection to other serotypes [1, 2] followed by an indeterminate period during which infection by another serotype may lead to more severe disease [3]. One theory for this increased severity is antibody dependent enhancement, whereby non-neutralizing antibodies bind to the virus and facilitate viral entry into cells and increased viral replication [4]. Infants have long been studied to understand the interaction between infection and disease on an individual level.
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