Sequential dengue virus (DENV) infections can result in antibody-dependent disease enhancement. As the Zika virus (ZIKV) and dengue virus envelope proteins are ~40% homologous, Katzelnick et al. explored whether immune interactions among different dengue virus serotypes extends to ZIKV. The authors followed a patient cohort in Nicaragua who have been sequentially exposed to DENV and ZIKV and found that the risk of symptomatic DENV serotype 2 (DENV-2) infection and severe disease was increased by one prior DENV or ZIKV infection. By contrast, multiple DENV infections reduced disease risk. High levels of pre-exisiting anti-DENV antibodies protected against DENV-1, DENV-3 and ZIKV infection, but intermediate levels of DENV or ZIKV antibodies increased the risk of severe disease in DENV-2 and DENV-3 infection, posing a challenge to DENV and ZIKV vaccine development.
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Katzelnick, L. C. et al. Zika virus infection enhances future risk of severe dengue disease. Science 369, 1123–1128 (2020)
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York, A. Zika virus enhances dengue risk. Nat Rev Microbiol 18, 605 (2020). https://doi.org/10.1038/s41579-020-00455-x
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DOI: https://doi.org/10.1038/s41579-020-00455-x