ArticlePLoS neglected tropical diseases2023
Direct and indirect effects of age on dengue severity: The mediating role of secondary infection.
Article in PLoS neglected tropical diseases, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Hemophagocytic Lymphohistiocytosis Triggered by Dengue: A Narrative Review and Individual Patient Data Meta-Analysis.Viruses · 2025Pooled it
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- Dengue epidemiology and transmission intensity across Panama during 2000-2024: a modelling study.Lancet regional health. Americas · 2026Article
- Dual role of Japanese encephalitis virus fusion loop peptide antibodies in Zika virus infection.PLoS neglected tropical diseases · 2026Article
- Metabolic and cardiovascular comorbidities as predictors of severe dengue in Vietnamese adults: a retrospective study, 2022-2024.Osong public health and research perspectives · 2026Article
- Risk factors associated with dengue lethality: case-control study, Joinville, Brazil.Revista da Sociedade Brasileira de Medicina Tropical · 2026Article
- Assessing dengue knowledge, attitudes and preventive practices in France and Italy: A cross-sectional study using participatory surveillance cohorts.PLOS global public health · 2026Article
- Dengue and severe dengue.Clinical microbiology reviews · 2025Review
- Inter-host diversity associated with age, sex, and menstrual cycle modulates clinical manifestations in DENV-2 patients.iScience · 2025Article
- Assessing the global dengue burden: Incidence, mortality, and disability trends over three decades.PLoS neglected tropical diseases · 2025Observational
- Risk factors for dengue mortality: a 7-year retrospective cohort in Honduras.BMC infectious diseases · 2025Article
- Effects of dengue virus type-2 serotype (DENV-2) on the expression profile of matrix metalloproteinases in THP-1, monocyte cells and their roles in endothelial dysfunctions: protective effect of atorvastatin.Frontiers in cellular and infection microbiology · 2025Article
- Dysregulated immune cell responses in severe dengue pathogenesis.Frontiers in immunology · 2025Review
- Clinical case of co-infection: Dengue fever and respiratory mycoplasmosis in a child.Respiratory medicine case reports · 2025Article
- Correlation between CRP and ferritin in dengue patients: A hospital-based prospective observational study.Journal of family medicine and primary care · 2024Article
- Dengue infections in India: A meta-analysis.Bioinformation · 2024Article
- Article
- Dengue Burden and Factors Influencing Severity in Honduras: A Descriptive and Analytical Study.Revista da Sociedade Brasileira de Medicina Tropical · 2024Article
Corrections and comments
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Authors and funding
5 authors at 5 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Severe dengue occurrence has been attributed to increasing age and different dengue virus (DENV) serotypes that cause secondary infections and immune-enhancing phenomena. Therefore, we examined if the effect of age on dengue severity was mediated by infectivity status while controlling for sex and region. Further, we assessed the spatial clustering of dengue severity for individuals with primary and secondary infection across Mexican municipalities. Health data from 2012 to 2017 was retrieved from Mexico's Ministry of Health. A mediation analysis was performed using multiple logistic regression models based on a directed acyclic graph. The models were explored for the direct effect of age on dengue severity and its indirect impact through secondary infection. In addition, severe dengue clusters were determined in some Northeastern and Southeastern municipalities through spatial analysis. We observed a nonlinear trend between age and severe dengue. There was a downward trend of severe dengue for individuals between 0 and 10 years and an upward trend above 10 years. The effect of age on dengue severity was no longer significant for individuals between 10 and 60 years after introducing infectivity status into the model. The mediating role of infectivity status in the causal model was 17%. Clustering of severe dengue among individuals with primary infection in the Northeastern region may point to the high prevalence of DENV-3 in the region. Public health efforts may prevent secondary infection among infants and the aged. In addition, there should be a further investigation into the effect of DENV-3 in individuals with primary disease.
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