title: Homotypic Dengue Virus Reinfections in Nicaraguan Children.
abstract: Infection with any of the 4 related dengue virus serotypes (DENV-1-4) is thought to result in lifelong immunity to homotypic reinfection (ie, reinfection with the same serotype).
  
  
  
  Archived serum samples collected as part of an ongoing pediatric dengue cohort study in Nicaragua were tested for DENV by real-time reverse transcription polymerase chain reaction. Samples were collected from 2892 children who presented with an acute febrile illness clinically attributed to a non-DENV cause (hereafter, "C cases"). Test results were added to a database of previously identified symptomatic dengue cases in the cohort to identify repeat infections.
  
  
  
  Four patients with homotypic DENV reinfections were identified and confirmed among 29 repeat DENV infections (13.8%) with serotype confirmation. Homotypic reinfections with DENV-1, DENV-2, and DENV-3 occurred 325-621 days after the initial infection. Each patient experienced 1 symptomatic dengue case and 1 DENV-positive C case, and 2 patients presented with symptomatic dengue during their second infection. These DENV-positive C cases did not elicit long-lived humoral immune responses, despite viremia levels of up to 6.44 log10 copies per mL of serum.
  
  
  
  We describe the first set of virologically confirmed homotypic DENV reinfections. Such cases challenge the current understanding of DENV immunity and have important implications for modeling DENV transmission.
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Department of Medicine.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Waggoner
authors.affiliation: National Virology Laboratory, Centro Nacional de Diagnóstico y Referencia.
authors.forename: Angel
authors.initials: A
authors.lastname: Balmaseda
authors.affiliation: Sustainable Sciences Institute, Managua, Nicaragua.
authors.forename: Lionel
authors.initials: L
authors.lastname: Gresh
authors.affiliation: Department of Pathology, Stanford University School of Medicine.
authors.forename: Malaya K
authors.initials: MK
authors.lastname: Sahoo
authors.affiliation: Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley.
authors.forename: Magelda
authors.initials: M
authors.lastname: Montoya
authors.affiliation: Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley.
authors.forename: Chunling
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Pathology, Stanford University School of Medicine.
authors.forename: Janaki
authors.initials: J
authors.lastname: Abeynayake
authors.affiliation: Centro de Salud Sócrates Flores Vivas, Ministry of Health.
authors.forename: Guillermina
authors.initials: G
authors.lastname: Kuan
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Department of Medicine Department of Pathology, Stanford University School of Medicine.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Pinsky
authors.affiliation: Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley.
authors.forename: Eva
authors.initials: E
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D003716:Dengue Virus / Q000145:classification* / Q000276:immunology / Q000302:isolation & purification*; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D012008:Recurrence; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D065288:Serogroup; D044967:Serum / Q000821:virology
chemical_list: D012367:RNA, Viral
keywords: dengue immunity; dengue virus; homotypic reinfection; repeat infection