Secondary dengue virus infection in communities with preexisting multiple heterotypic dengue virus antibodies: A longitudinal study in Malaysia

Results: A total of 277 and 316 afebrile adults participated in the first round (baseline) blood collection in Segamat and Shah Alam, a low and high dengue burden site, respectively. A total of 87% and 80% of the participants of Segamat and Shah Alam showed at baseline (first blood collection), previous exposures to dengue and against all 4 DENV serotypes. However, none of the participants reported previous history of high fever or admissions into hospital for dengue. Overall, secondary infections of participants with multiple heterotypic antibody responses were found in 22.8% and 20.6% from Shah Alam and Segamat, respectively. Interestingly, participants with high or low level of pre-existing multiple heterotypic DENV antibodies, when newly or reinfected with DENV were asymptomatic based on IgM and anamnestic responses of FRNT90 > 1250 for any of the 4 serotypes.
Conclusion: In our study, participants with preexisting multiple heterotypic DENV antibodies were asymptomatic upon secondary DENV infection. The effect of ADE was not observed. Broad neutralizing antibodies might have protected these participants.