Insights into the natural history of dengue virus infection guide vaccine development Dengue virus (DENV) is a member of the viral genus Flavivirus, which also includes yellow fever virus (YFV) and Zika virus (ZIKV). DENV infection is a major and growing global health threat: There are ∼400 million cases of infection, ∼500,000 hospitalizations, and ∼12,500 deaths now estimated to occur each year (1). Dengue represents the most common mosquito-borne disease in humans (1). A remarkable 50% of the world's population now lives in regions where DENV transmission is manifest. Dengue is associated with a wide spectrum of clinical outcomes, ranging from mild febrile illnesses to dengue hemorrhagic fever to the most severe clinical presentation of dengue shock syndrome, which is characterized by profound systemic cytokine activation, vascular leakage, and shock—this carries a high risk of death. On page 929 of this issue, Katzelnick et al. (2) analyzed DENV infection outcome data gleaned from the long-term followup of a cohort of Nicaraguan children (2). They found that the risk of severe dengue disease upon subsequent DENV infection correlated with baseline DENV antibody concentrations (titers), which has implications for DENV vaccination approaches.

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推进登革热疫苗开发

深入了解登革热病毒感染的自然史指导疫苗开发 登革热病毒 (DENV) 是黄病毒属病毒的成员，该属还包括黄热病病毒 (YFV) 和寨卡病毒 (ZIKV)。DENV 感染是一个主要且日益严重的全球健康威胁：现在估计每年有约 4 亿例感染病例、约 500,000 例住院治疗和约 12,500 例死亡 (1)。登革热是人类最常见的蚊媒疾病 (1)。现在，世界上 50% 的人口生活在 DENV 传播明显的地区。登革热与广泛的临床结果相关，从轻度发热性疾病到登革出血热，再到登革休克综合征最严重的临床表现，其特征是严重的全身细胞因子激活、血管渗漏、和休克——这会带来很高的死亡风险。在本期第 929 页上，Katzelnick 等人。(2) 分析了从尼加拉瓜儿童队列的长期随访中收集的 DENV 感染结果数据 (2)。他们发现，随后 DENV 感染后出现严重登革热病的风险与基线 DENV 抗体浓度（滴度）相关，这对 DENV 疫苗接种方法有影响。