Homotypic Dengue Virus Reinfections in Nicaraguan Children

J Infect Dis. 2016 Oct 1;214(7):986-93. doi: 10.1093/infdis/jiw099. Epub 2016 Mar 16.


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 log10 copies 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.

Keywords: dengue immunity; dengue virus; homotypic reinfection; repeat infection.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Dengue / epidemiology*
  • Dengue / immunology
  • Dengue / virology*
  • Dengue Virus / classification*
  • Dengue Virus / immunology
  • Dengue Virus / isolation & purification*
  • Female
  • Genotype
  • Humans
  • Male
  • Nicaragua / epidemiology
  • Prospective Studies
  • RNA, Viral / genetics
  • Real-Time Polymerase Chain Reaction
  • Recurrence
  • Retrospective Studies
  • Reverse Transcriptase Polymerase Chain Reaction
  • Serogroup*
  • Serum / virology


  • RNA, Viral