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Review
. 2002 Dec;8(12):1474-9.
doi: 10.3201/eid0812.020170.

Dengue hemorrhagic fever in infants: research opportunities ignored

Scott B Halstead  1 , Nguyen Trong Lan, Thein Thein Myint, Than Nu Shwe, Ananda Nisalak, Siripen Kalyanarooj, Suchitra Nimmannitya, Soegeng Soegijanto, David W Vaughn, Timothy P Endy
Affiliations
Review

Dengue hemorrhagic fever in infants: research opportunities ignored

Scott B Halstead et al. Emerg Infect Dis. 2002 Dec.

Abstract

The age distribution of cases of dengue hemorrhagic fever and dengue shock syndrome (DHF/DSS) in infants under the age of 1 year are reported from Bangkok, Thailand, and for the first time for Ho Chi Minh City, Vietnam; Yangon, Myanmar; and Surabaya, Indonesia. The four dengue viruses were isolated from Thai infants, all of whom were having a primary dengue infection. Progress studying the immunologically distinct infant DHF/DSS has been limited; most contemporary research has centered on DHF/DSS accompanying secondary dengue infections. In designing research results obtained in studies on a congruent animal model, feline infectious peritonitis virus (FIPV) infections of kittens born to FIPV-immune queens should be considered. Research challenges presented by infant DHF/DSS are discussed.

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Figures

Figure 1
Figure 1
Age-specific hospitalization rates/1,000 infants with dengue hemorrhagic fever/dengue shock syndrome, Bangkok, Thailand, 1962–1964. Source: Halstead SB, et al. Am J Trop Med Hyg (17); cited with permission.
Figure 2
Figure 2
Month of age of infants hospitalized for dengue hemorrhagic fever/dengue shock syndrome at the Bangkok Children’s Hospital, 1995–1998 (Thailand), Children’s Hospital No.1, Ho Chi Minh City, 1995–1998 (Vietnam), Yangon Children’s Hospital, 1995–1998 (Myanmar) and Dr. Soetomo Hospital, Surabaya, 1996–1999 (Indonesia). Data are combined for the period shown.
Figure 3
Figure 3
Year of age at hospitalization of children with dengue hemorrhagic fever/dengue shock syndrome, Yangon Children’s Hospital, Yangon, Myanmar, 1995–1998, combined.
Figure 4
Figure 4
Year of age of children hospitalized for dengue hemorrhagic fever/dengue shock syndrome at Bangkok Children’s Hospital, Bangkok, Thailand, 1990–1999, combined.
Figure 5
Figure 5
Relationship between the age distributions of infants hospitalized for dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) and the protective and infection-enhancing effects of maternal dengue antibodies. Shown are mean age specific hospitalization rate/1,000 for Bangkok and Thonburi, 1962–1964 (see Figure 1). At birth, antibodies are at protective concentrations. With the passage of time, maternal immunoglobulin G antibodies are catabolized to concentrations that result in antibody-dependent enhancement (ADE) of infections. By the end of the first year of life, ADE antibodies are catabolized to concentrations below the ADE threshold, and DHF/DSS cases disappear.
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