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Analysis of Repeat Hospital Admissions for Dengue to Estimate the Frequency of Third or Fourth Dengue Infections Resulting in Admissions and Dengue Hemorrhagic Fever, and Serotype Sequences

Immunity to a single dengue virus (DENV) infection does not provide heterologous immunity to subsequent infection. In fact, the greatest risk for dengue hemorrhagic fever (DHF) is with a second DENV serotype exposure. The risk for DHF with a third or fourth dengue infection relative to a first or second exposure is not known. An analysis of our database of children admitted to the Queen Sirikit National Institute of Child Health and Kamphaeng Phet Provincial Hospital with suspected dengue illness revealed that the number of dengue admissions caused by a third or fourth DENV infection was extremely low (0.08–0.8%). Once admitted, the risk for DHF relative to dengue fever was not different for those experiencing third or fourth DENV infections over those experiencing a second DENV infection. We document new dengue serotype infection sequences leading to DHF of 1–4, 2–3, 3–1, and 3–4.

Received March 15, 2007. Accepted for publication July 11, 2007.

Acknowledgments: The authors thank Tipawan Thipwong for outstanding database support, making this research and publication possible. We also acknowledge the assistance of Panor Srisongkram, Napaporn Latthiwongsakorn, Sumitda Narupiti, Vipa Thirawuth, and Butsaya Thaisomboonsuk; without their assistance, this study could not have been completed. Last, we thank all of our collaborators at QSNICH, especially Suchitra Nimmannitya.

Financial support: Funding was partially provided by the US Military Infectious Diseases Research Program, Fort Detrick, MD, and the National Institutes of Health (NIH-P01-AI34533).

Disclosure: The opinions or assertions contained herein are the personal views of the authors and are not to be construed as official or reflecting the views of the Armed Forces Research Institute of Medical Sciences, the United States Department of the Army, or the United States Department of Defense.

^* Address correspondence to Robert V. Gibbons, APO-AP, Bangkok 96546, Thailand. E-mail: Robert.gibbons{at}afrims.org

Authors’ addressses: Robert V. Gibbons, USAMC-AFRIMS APO AP, 96566, Telephone: 662-6444674, Fax: 662-6444760, E-mail: robert.gibbons{at}afrims.org. Siripen Kalanarooj, Queen Sirikit National Institute of Child Health, 420/8 Rajvithi Road, Bangkok, Thailand 10400, Telephone: 662-354-8434, E-mail: ph sirip{at}health.moph.go.th. Richard G. Jarman, USAMC-AFRIMS APO AP, 96566, Telephone: 662-6444674, Fax: 662-6444760, E-mail: richard.jarman{at}afrims.org. Ananda Nisaluk, AFRIMS, 315/6 Rajvithi Road, Bangkok, Thailand 10400, Telephone: 662-6444674, Fax: 662-6444760, E-mail: Ananda.nisaluk{at}afrims.org. David W. Vaughn, GlaxoSmithKline, 2301 Renaissance Boulevard, RN0220, King of Prussia, PA 19406, Telephone: 610-787-3907, Fax: 610-787-7057, E-mail: d.w.vaughn{at}usa.net. Timothy P. Endy, WRAIR, Division of Communicable Diseases and Immunology, 503 Robert Grant Ave., Silver Spring, MD 90210, Telephone: 301-319-3053, Fax: 301-319-3053, E-mail: endyt{at}upstate.edu. Mammen P. Mammen Jr, Product Manager, Pharmaceutical Systems Division, US Army Medical Material Development Activity (USAMMDA), 1430 Veterans Drive, Ft. Detrick, MD 21702, Telephone: 301-619-2069, Fax: 301-619-2304, E-mail: mammen.mammen{at}amedd.army.mil. Anon Srikiatkhachorn, Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, 55 Lake Avenue, North Worcester, MA 01557, Telephone: 508-856-4182, Fax: 508-856-4890, E-mail: anon.srikiatkhachorn{at}umassmed.edu.