COVID-19 Vaccines: Should We Fear ADE?

J Infect Dis. 2020 Nov 13;222(12):1946-1950. doi: 10.1093/infdis/jiaa518.


Might COVID-19 vaccines sensitize humans to antibody-dependent enhanced (ADE) breakthrough infections? This is unlikely because coronavirus diseases in humans lack the clinical, epidemiological, biological, or pathological attributes of ADE disease exemplified by dengue viruses (DENV). In contrast to DENV, SARS and MERS CoVs predominantly infect respiratory epithelium, not macrophages. Severe disease centers on older persons with preexisting conditions and not infants or individuals with previous coronavirus infections. Live virus challenge of animals given SARS or MERS vaccines resulted in vaccine hypersensitivity reactions (VAH), similar to those in humans given inactivated measles or respiratory syncytial virus vaccines. Safe and effective COVID-19 vaccines must avoid VAH.

Keywords: SARS-CoV-2; T cells; antibody-dependent enhancement (ADE); coronavirus; dengue; dengue hemorrhagic fever; hypersensitivity; immunopathology; vaccine; vaccine adverse events.

Publication types

  • Review

MeSH terms

  • Animals
  • Antibody-Dependent Enhancement*
  • COVID-19 / prevention & control*
  • COVID-19 Vaccines / adverse effects
  • COVID-19 Vaccines / immunology*
  • Dengue Vaccines / immunology
  • Humans
  • Hypersensitivity / etiology
  • SARS-CoV-2 / immunology
  • Severe acute respiratory syndrome-related coronavirus / immunology


  • COVID-19 Vaccines
  • Dengue Vaccines