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Viral Infections and Outbreaks Research / Virology and Viral Diseases / Mosquito Borne Diseases and Control · Journal article
International Journal of Infectious Diseases · July 27, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a descriptive serological study of 50 Vietnamese pediatric dengue cases showing that secondary infections and dengue shock syndrome (DSS) cases exhibit both elevated neutralizing antibody titers and enhanced antibody-dependent enhancement (ADE) activity against dengue and cross-reactive against JEV and ZIKV. The findings are mechanistic, raising a hypothesis about the coexistence of protective and pathogenic responses but lack clinical outcome data or a comparator group to establish causality or clinical significance.
Observational cross-sectional study with paired acute and convalescent sera. Pediatric dengue patients from southern Vietnam enrolled during 2015–2017, with primary and secondary infections and a spectrum of disease severity including dengue shock syndrome.. n = 50. Southern Vietnam.
NAb responses detected against all DENV serotypes, highest against DENV-1, with titers increasing during convalescence and generally higher in secondary than primary infections ADE activity most pronounced against DENV-2 and lowest against DENV-4; Peak enhancement titers (PET) higher in convalescent samples, secondary infections, and DSS cases PET positively correlated with NAb titers across the cohort
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
The findings suggest that heightened antibody responses in severe dengue and secondary infections may include both protective and enhancing components, relevant to understanding flavivirus vaccine safety and dengue immunopathogenesis. However, the in vitro nature of the measures and absence of clinical outcome validation limits direct clinical application.
Single-center observational study of paired sera from 50 pediatric cases measuring antibody responses; descriptive findings without a comparator group or intervention, addressing mechanistic immunology rather than clinical outcomes.
As stated by the source record.
Quoted from the source exactly as published.
The findings suggest that heightened antibody responses in severe dengue and secondary infections may include both protective and enhancing components, relevant to understanding flavivirus vaccine safety and dengue immunopathogenesis. However, the in vitro nature of the measures and absence of clinical outcome validation limits direct clinical application.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
OBJECTIVES: Understanding the balance between protective and pathogenic antibody responses is central to dengue immunology and flavivirus vaccine development. METHODS: Fifty paired acute and convalescent serum samples from pediatric dengue patients in southern Vietnam (2015-2017) were analyzed, including primary and secondary infections across a spectrum of disease severity. Primary and secondary DENV infections were classified using an in-house validated DENV IgG ELISA. Neutralizing antibody (NAb) titers and antibody-dependent enhancement (ADE) activities were evaluated against dengue virus the four serotypes (DENV), Japanese encephalitis virus (JEV) and ZIKA (ZIKV) using single-round infectious particles (SRIPs). RESULTS: Neutralizing antibody (NAb) responses were detected against all DENV serotypes and were highest against DENV-1. NAb titers increased during convalescence and were generally higher in secondary than primary infections. Higher NAb titers were also observed in convalescent sera from DSS cases compared with other clinical groups. ADE activity was most pronounced against DENV-2 and was lowest against DENV-4, while Peak enhancement titers (PET) were higher in convalescent samples, secondary infections, and DSS cases, and were positively correlated with NAb titers. Additionally, higher enhancement activity was observed in sera from DSS cases than in those from milder disease categories. Cross-reactive neutralizing and enhancing antibodies against JEV and ZIKV were also detected, with stronger enhancement observed against ZIKV. CONCLUSION: Heightened neutralizing immunity in secondary and severe dengue is accompanied by expanded enhancement potential, indicating an expanded, cross-reactive immune response driven by immune activation upon infection. The coexistence of protective and enhancing antibodies may contribute both to viral control and to immunopathogenesis during subsequent flavivirus infections.
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