ArticleNature medicine2024
Severe disease during both primary and secondary dengue virus infections in pediatric populations.
Article in Nature medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.
- HLA alleles and dengue susceptibility across populations in the era of climate change: a comprehensive review.Frontiers in immunology · 2025Pooled it
- Dengue virus infection.Nature reviews. Disease primers · 2026Review
- Unresolved questions in pediatric dengue: from disease mechanisms to prevention.Current opinion in infectious diseases · 2026Review
- Functional antibody responses and protection against symptomatic dengue.Communications medicine · 2026Review
- Severe Dengue in Children: Pathogenesis, Early Recognition, and Evidence-Informed Management.Tropical medicine and infectious disease · 2026Review
- Epidemic Years Increase Hospitalization but Not Mortality Among Laboratory-Confirmed Dengue Cases in Mexico: A Nationwide Surveillance Study, 2020-2025.Microorganisms · 2026Article
- Human Antibody Isotypes, Subclasses, Allotypes and Fc Biology: Clinical Implications in Infectious Diseases, Autoimmunity, and Cancer.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Bulk transcriptomics of peripheral blood mononuclear cells delineates systems-level immune dysregulation in pediatric dengue infection.NPJ systems biology and applications · 2026Article
- Article
- Acute-Phase Dengue Antibody Profiles in Pediatric Patients: Influence on Viremia and Disease Manifestations.Viruses · 2026Article
- Epidemiological, virological, and clinical characteristics of dengue in the Lao People's Democratic Republic, 2022-2023: a cross-sectional study.Tropical medicine and health · 2026Article
- Dengue and chikungunya virus transmission in Kinshasa, Democratic Republic of the Congo.medRxiv : the preprint server for health sciences · 2026Article
- Fever in the Returning Traveler: A Practical Overview for Initial Management and Assessment in the ED.Journal of clinical medicine · 2026Review
- A secretion-deficient DENV1 DNA vaccine induces durable immunity and confers protection against DENV2.Zoological research · 2026Article
- Metabolomic atlas of dengue virus infection reveals distinct circulating bioactive lipid signatures.PLoS neglected tropical diseases · 2026Article
- Evaluation of Serum Ferritin Levels and Their Correlation With Clinical Outcomes in Dengue Virus Infection in a Population of Older Adults.Tropical medicine & international health : TM & IH · 2026Article
- IgG3 Hinge Architecture Expands Dengue Virus Breadth of A Quaternary Epitope Dependent Zika Virus Cross-Neutralizing Antibody.bioRxiv : the preprint server for biology · 2026Article
- Characterising secondary dengue infections in Saudi Arabia using combined IgG and PCR testing.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2026Article
- CD8+ T cells and Humoral Immunity Influence the Development of Antibody-Dependent Enhancement: Implications for Vaccine Design.bioRxiv : the preprint server for biology · 2026Article
- Characteristics, Motivation, and Challenges of Global Research on Dengue Vaccination.Reviews in medical virology · 2026Review
Corrections and comments
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Authors and funding
42 authors at 11 institutions in 3 countries.
Funding
Abstract
Dengue is a global epidemic causing over 100 million cases annually. The clinical symptoms range from mild fever to severe hemorrhage and shock, including some fatalities. The current paradigm is that these severe dengue cases occur mostly during secondary infections due to antibody-dependent enhancement after infection with a different dengue virus serotype. India has the highest dengue burden worldwide, but little is known about disease severity and its association with primary and secondary dengue infections. To address this issue, we examined 619 children with febrile dengue-confirmed infection from three hospitals in different regions of India. We classified primary and secondary infections based on IgM:IgG ratios using a dengue-specific enzyme-linked immunosorbent assay according to the World Health Organization guidelines. We found that primary dengue infections accounted for more than half of total clinical cases (344 of 619), severe dengue cases (112 of 202) and fatalities (5 of 7). Consistent with the classification based on binding antibody data, dengue neutralizing antibody titers were also significantly lower in primary infections compared to secondary infections (P ≤ 0.0001). Our findings question the currently widely held belief that severe dengue is associated predominantly with secondary infections and emphasizes the importance of developing vaccines or treatments to protect dengue-naive populations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.