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期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-024-02798-x

摘要内容如下：

登革热是一种全球流行病，每年造成1亿多病例。临床症状从轻度发热到严重出血和休克，包括一些死亡。目前的范例是，这些严重的登革热病例大多发生在继发感染期间，这是由于感染不同的登革病毒血清型后抗体依赖性增强所致。印度是世界上登革热负担最高的国家，但人们对疾病的严重程度及其与原发性和继发性登革热感染的关系知之甚少。为了解决这一问题，我们检查了来自印度不同地区三家医院的619名确诊感染发热性登革热的儿童。我们根据世界卫生组织指南，使用登革热特异性酶联免疫吸附试验，根据IgM：IgG比值对原发和继发感染进行分类。我们发现，原发性登革热感染占临床病例总数（619例中的344例）、重症登革热病例（202例中的112例）和死亡病例（7例中的5例）的一半以上。与基于结合抗体数据的分类一致，登革热中和抗体滴度在原发感染中也显著低于继发感染（p≤0.0001）。我们的研究结果质疑了目前普遍持有的观点，即严重登革热主要与继发感染有关，并强调了开发疫苗或治疗方法以保护未患登革热人群的重要性。

英文原文如下：

Abstracts

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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