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Prior dengue virus infection and risk of Zika: A pediatric cohort in Nicaragua.
PLoS Med. 2019 01; 16(1):e1002726.PM

Abstract

BACKGROUND

Zika virus (ZIKV) emerged in northeast Brazil in 2015 and spread rapidly across the Americas, in populations that have been largely exposed to dengue virus (DENV). The impact of prior DENV infection on ZIKV infection outcome remains unclear. To study this potential impact, we analyzed the large 2016 Zika epidemic in Managua, Nicaragua, in a pediatric cohort with well-characterized DENV infection histories.

METHODS AND FINDINGS

Symptomatic ZIKV infections (Zika cases) were identified by real-time reverse transcription PCR and serology in a community-based cohort study that follows approximately 3,700 children aged 2-14 years old. Annual blood samples were used to identify clinically inapparent ZIKV infections using a novel, well-characterized serological assay. Multivariable Poisson regression was used to examine the relation between prior DENV infection and incidence of symptomatic and inapparent ZIKV infection. The generalized-growth method was used to estimate the effective reproduction number. From January 1, 2016, to February 28, 2017, 560 symptomatic ZIKV infections and 1,356 total ZIKV infections (symptomatic and inapparent) were identified, for an overall incidence of 14.0 symptomatic infections (95% CI: 12.9, 15.2) and 36.5 total infections (95% CI: 34.7, 38.6) per 100 person-years. Effective reproduction number estimates ranged from 3.3 to 3.4, depending on the ascending wave period. Incidence of symptomatic and total ZIKV infections was higher in females and older children. Analysis of the effect of prior DENV infection was performed on 3,027 participants with documented DENV infection histories, of which 743 (24.5%) had experienced at least 1 prior DENV infection during cohort follow-up. Prior DENV infection was inversely associated with risk of symptomatic ZIKV infection in the total cohort population (incidence rate ratio [IRR]: 0.63; 95% CI: 0.48, 0.81; p < 0.005) and with risk of symptomatic presentation given ZIKV infection (IRR: 0.62; 95% CI: 0.44, 0.86) when adjusted for age, sex, and recent DENV infection (1-2 years before ZIKV infection). Recent DENV infection was significantly associated with decreased risk of symptomatic ZIKV infection when adjusted for age and sex, but not when adjusted for prior DENV infection. Prior or recent DENV infection did not affect the rate of total ZIKV infections. Our findings are limited to a pediatric population and constrained by the epidemiology of the site.

CONCLUSIONS

These findings support that prior DENV infection may protect individuals from symptomatic Zika. More research is needed to address the possible immunological mechanism(s) of cross-protection between ZIKV and DENV and whether DENV immunity also modulates other ZIKV infection outcomes such as neurological or congenital syndromes.

Authors+Show Affiliations

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America.Sustainable Sciences Institute, Managua, Nicaragua.Sustainable Sciences Institute, Managua, Nicaragua.Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America.Sustainable Sciences Institute, Managua, Nicaragua.Sustainable Sciences Institute, Managua, Nicaragua. Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua.Georgia State University, Atlanta, Georgia, United States of America.Sustainable Sciences Institute, Managua, Nicaragua.Sustainable Sciences Institute, Managua, Nicaragua.Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America.Sustainable Sciences Institute, Managua, Nicaragua. Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America.Health Center Sócrates Flores Vivas, Ministry of Health, Managua, Nicaragua.Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua.Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30668565

Citation

Gordon, Aubree, et al. "Prior Dengue Virus Infection and Risk of Zika: a Pediatric Cohort in Nicaragua." PLoS Medicine, vol. 16, no. 1, 2019, pp. e1002726.
Gordon A, Gresh L, Ojeda S, et al. Prior dengue virus infection and risk of Zika: A pediatric cohort in Nicaragua. PLoS Med. 2019;16(1):e1002726.
Gordon, A., Gresh, L., Ojeda, S., Katzelnick, L. C., Sanchez, N., Mercado, J. C., Chowell, G., Lopez, B., Elizondo, D., Coloma, J., Burger-Calderon, R., Kuan, G., Balmaseda, A., & Harris, E. (2019). Prior dengue virus infection and risk of Zika: A pediatric cohort in Nicaragua. PLoS Medicine, 16(1), e1002726. https://doi.org/10.1371/journal.pmed.1002726
Gordon A, et al. Prior Dengue Virus Infection and Risk of Zika: a Pediatric Cohort in Nicaragua. PLoS Med. 2019;16(1):e1002726. PubMed PMID: 30668565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prior dengue virus infection and risk of Zika: A pediatric cohort in Nicaragua. AU - Gordon,Aubree, AU - Gresh,Lionel, AU - Ojeda,Sergio, AU - Katzelnick,Leah C, AU - Sanchez,Nery, AU - Mercado,Juan Carlos, AU - Chowell,Gerardo, AU - Lopez,Brenda, AU - Elizondo,Douglas, AU - Coloma,Josefina, AU - Burger-Calderon,Raquel, AU - Kuan,Guillermina, AU - Balmaseda,Angel, AU - Harris,Eva, Y1 - 2019/01/22/ PY - 2018/07/05/received PY - 2018/12/13/accepted PY - 2019/1/23/entrez PY - 2019/1/23/pubmed PY - 2019/5/14/medline SP - e1002726 EP - e1002726 JF - PLoS medicine JO - PLoS Med VL - 16 IS - 1 N2 - BACKGROUND: Zika virus (ZIKV) emerged in northeast Brazil in 2015 and spread rapidly across the Americas, in populations that have been largely exposed to dengue virus (DENV). The impact of prior DENV infection on ZIKV infection outcome remains unclear. To study this potential impact, we analyzed the large 2016 Zika epidemic in Managua, Nicaragua, in a pediatric cohort with well-characterized DENV infection histories. METHODS AND FINDINGS: Symptomatic ZIKV infections (Zika cases) were identified by real-time reverse transcription PCR and serology in a community-based cohort study that follows approximately 3,700 children aged 2-14 years old. Annual blood samples were used to identify clinically inapparent ZIKV infections using a novel, well-characterized serological assay. Multivariable Poisson regression was used to examine the relation between prior DENV infection and incidence of symptomatic and inapparent ZIKV infection. The generalized-growth method was used to estimate the effective reproduction number. From January 1, 2016, to February 28, 2017, 560 symptomatic ZIKV infections and 1,356 total ZIKV infections (symptomatic and inapparent) were identified, for an overall incidence of 14.0 symptomatic infections (95% CI: 12.9, 15.2) and 36.5 total infections (95% CI: 34.7, 38.6) per 100 person-years. Effective reproduction number estimates ranged from 3.3 to 3.4, depending on the ascending wave period. Incidence of symptomatic and total ZIKV infections was higher in females and older children. Analysis of the effect of prior DENV infection was performed on 3,027 participants with documented DENV infection histories, of which 743 (24.5%) had experienced at least 1 prior DENV infection during cohort follow-up. Prior DENV infection was inversely associated with risk of symptomatic ZIKV infection in the total cohort population (incidence rate ratio [IRR]: 0.63; 95% CI: 0.48, 0.81; p < 0.005) and with risk of symptomatic presentation given ZIKV infection (IRR: 0.62; 95% CI: 0.44, 0.86) when adjusted for age, sex, and recent DENV infection (1-2 years before ZIKV infection). Recent DENV infection was significantly associated with decreased risk of symptomatic ZIKV infection when adjusted for age and sex, but not when adjusted for prior DENV infection. Prior or recent DENV infection did not affect the rate of total ZIKV infections. Our findings are limited to a pediatric population and constrained by the epidemiology of the site. CONCLUSIONS: These findings support that prior DENV infection may protect individuals from symptomatic Zika. More research is needed to address the possible immunological mechanism(s) of cross-protection between ZIKV and DENV and whether DENV immunity also modulates other ZIKV infection outcomes such as neurological or congenital syndromes. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/30668565/Prior_dengue_virus_infection_and_risk_of_Zika:_A_pediatric_cohort_in_Nicaragua_ L2 - https://dx.plos.org/10.1371/journal.pmed.1002726 DB - PRIME DP - Unbound Medicine ER -