Journal
SCIENCE
Volume 358, Issue 6365, Pages 929-932Publisher
AMER ASSOC ADVANCEMENT SCIENCE
DOI: 10.1126/science.aan6836
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Funding
- NIH [P01AI106695, U19AI118610, R01AI099631]
- Pediatric Dengue Vaccine Initiative grant from Bill and Melinda Gates Foundation
- FIRST grant from Bill and Melinda Gates Foundation
- Takeda Vaccines
- Institutional Review Boards of the Nicaraguan Ministry of Health
- University of California, Berkeley
- University of Michigan
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For dengue viruses 1 to 4 (DENV1-4), a specific range of antibody titer has been shown to enhance viral replication in vitro and severe disease in animal models. Although suspected, such antibody-dependent enhancement of severe disease has not been shown to occur in humans. Using multiple statistical approaches to study a long-term pediatric cohort in Nicaragua, we show that risk of severe dengue disease is highest within a narrow range of preexisting anti-DENV antibody titers. By contrast, we observe protection from all symptomatic dengue disease at high antibody titers. Thus, immune correlates of severe dengue must be evaluated separately from correlates of protection against symptomatic disease. These results have implications for studies of dengue pathogenesis and for vaccine development, because enhancement, not just lack of protection, is of concern.
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