Dengue Hemorrhagic Fever in Infants: Research Opportunities Ignored
Scott B. Halstead* , Nguyen Trong Lan†, Thein Thein Myint‡, Than Nu Shwe‡, Ananda Nisalak§, Siripen Kalyanarooj¶, Suchitra Nimmannitya¶, Soegeng Soegijanto#, David W. Vaughn§, and Timothy P. Endy§
Author affiliations: *Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; †Children’s Hospital No. 1, Ho Chi Minh City, Vietnam; ‡Yangon Children’s Hospital, Yangon, Myanmar;; §Armed Forces Research Institute of the Medical Sciences, Bangkok, Thailand; ¶Queen Sirikit National Institute of Child Health, Bangkok, Thailand; #Dr. Soetomo Hospital, Airlangga University Medical School, Surabaya, Indonesia;
Figure 5. Relationship between the age distributions of infants hospitalized for dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) and the protective and infection-enhancing effects of maternal dengue antibodies. Shown are mean age specific hospitalization rate/1,000 for Bangkok and Thonburi, 1962–1964 (see Figure 1). At birth, antibodies are at protective concentrations. With the passage of time, maternal immunoglobulin G antibodies are catabolized to concentrations that result in antibody-dependent enhancement (ADE) of infections. By the end of the first year of life, ADE antibodies are catabolized to concentrations below the ADE threshold, and DHF/DSS cases disappear.
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