Influence of previous Zika virus infection on acute dengue episode

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Estofolete, Cassia F. ; Versiani, Alice F. ; Dourado, Fernanda S. ; Milhim, Bruno H. G. A. ; Pacca, Carolina C. ; Silva, Gislaine C. D. ; Zini, Nathalia ; dos Santos, Barbara F. ; Gandolfi, Flora A. ; Mistrao, Natalia F. B. ; Garcia, Pedro H. C. ; Rocha, Rodrigo S. ; Gehrke, Lee ; Bosch, Irene ; Marques, Rafael E. ; Teixeira, Mauro M. ; da Fonseca, Flavio G. ; Vasilakis, Nikos ; Nogueira, Mauricio L.

• Document type: Journal article
• Source: PLoS Neglected Tropical Diseases; v. 17, n. 11, p. 25-pg., 2023-11-01.

Abstract

BackgroundThe co-circulation of flaviviruses in tropical regions has led to the hypothesis that immunity generated by a previous dengue infection could promote severe disease outcomes in subsequent infections by heterologous serotypes. This study investigated the influence of antibodies generated by previous Zika infection on the clinical outcomes of dengue infection.Methodology/Principal findingsWe enrolled 1,043 laboratory confirmed dengue patients and investigated their prior infection to Zika or dengue. Severe forms of dengue disease were more frequent in patients with previous Zika infection, but not in those previously exposed to dengue.Conclusions/SignificanceOur findings suggest that previous Zika infection may represent a risk factor for subsequent severe dengue disease, but we did not find evidence of antibody-dependent enhancement (higher viral titer or pro-inflammatory cytokine overexpression) contributing to exacerbation of the subsequent dengue infection. Although dengue is a disease known for years in the world and has been affecting several continents, some aspects remain unclear. One of them is about the possible factors that may influence the development of severe forms of the disease. Much has been discussed about the influence of a previous dengue episode, but the global spreading of other flaviviruses to areas where dengue was already circulating has aroused interest regarding a role like the other dengue serotypes. In this sense, the recent spreading of the Zika virus has become a factor of interest. In this study, the prior Zika virus infection was associated with a higher frequency of more severe forms in subsequent dengue. Preliminary findings did not suggest that the mechanism is the same one triggered in secondary dengue, known as antibody-dependent enhancement. These findings are a stimulus to develop further research that can understand the potential mechanisms involved in the pathogenesis. (AU)

• FAPESP's process: 22/03645-1 - Study of the virus-vector interaction and the mechanisms involved in modulating the dynamics of viral transmission
• Grantee: Maurício Lacerda Nogueira
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 22/09229-0 - Influence of previous exposure to Zika Virus on acute Dengue infection: epidemiological, clinical, immunological, and virological aspects
• Grantee: Cássia Fernanda Estofolete
• Support Opportunities: Regular Research Grants
• FAPESP's process: 18/17647-0 - Development of a peptide-based serologic multiplex diagnostic nanodevices to differentially identify Dengue and Zika infections
• Grantee: Alice Freitas Versiani
• Support Opportunities: Scholarships in Brazil - Post-Doctoral