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3202596 
Journal Article 
Homotypic Dengue Virus Reinfections in Nicaraguan Children 
Waggoner, JJ; Balmaseda, A; Gresh, L; Sahoo, MK; Montoya, M; Wang, C; Abeynayake, J; Kuan, G; Pinsky, BA; Harris, E 
2016 
Yes 
Journal of Infectious Diseases
ISSN: 0022-1899
EISSN: 1537-6613 
English 
26984144 
BACKGROUND:  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).

METHODS:  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.

RESULTS:  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 log10copies per mL of serum.

CONCLUSIONS:  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.