Dengue Virus
Dengue is a mosquito-borne disease caused by four serotypes of dengue virus (DENV1–DENV4) and is currently the most common arbovirus (arthropod-transmitted) disease worldwide. Primary infection with any of the four DV serotypes typically results in dengue fever (DF), a relatively mild influenza-like illness which subsequently provides lifelong immunity to the infecting strain. However, the bad news is that secondary infection with different DV serotype is associated with an increased risk of developing more serious conditions such as dengue haemorrhagic fever (DHF) and the life-threatening dengue shock syndrome (DSS).
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The first well documented outbreaks of dengue occurred in the eighteenth century, although the disease may have been around in China eight hundred years earlier. Dengue virus was first isolated by Japanese and American scientists during World War II. Dengue is now a major public health problem, with approximately 50 million people infected each year (of whom around 20,000 die) and nearly half the world’s population, about 3.5 billion people, at risk of infection. Unfortunately, no dengue virus-specific therapies or vaccines are currently available. The incidence of dengue infection has increased dramatically in the past 50 years. This is due in part to population growth and urbanization in tropical and subtropical countries. Originally found in the jungles and rural areas of Southeast Asia, dengue virus is now maintained primarily in an urban cycle involving human hosts and Aedes aegypti and A. albopictus mosquitoes. Urban areas frequently contain many breeding sites for the mosquitoes that transmit the virus, such as rain-filled old tyres. Successful mosquito control has also been problematic. Dengue viruses have evolved rapidly as they have spread worldwide, and genotypes associated with increased virulence have expanded from South and Southeast Asia into the Pacific and the Americas.
The pathogenesis of dengue haemorrhagic fever and dengue shock syndrome remain unclear. The requirement for a second infection with a different serotype of the virus suggested that antibody-dependent enhancement is involved in these more serious conditions. After an initial period of protection, antibodies from the primary infection can cross-react with other dengue virus serotypes but have waned to non-neutralizing levels. These non-neutralizing antibodies could then mediate an increased uptake of virus into monocyte/macrophage cells via Fc receptors, leading to increased virus replication and immune activation including massive cytokine release (known as a “cytokine storm”). An alternative theory involves reactivation of cross-reactive memory T cells specific for the previous rather than the current virus strain, resulting in delayed virus clearance and/or increased cytokine secretion along with increased apoptosis of both infected and uninfected bystander cells (known as “original antigenic sin”).
With only around 65% homology based on amino acid sequence, the four dengue viruses could have been classified as separate virus groups but instead are treated as four serotypes belonging to a single group. It appears that there may be differences between the viruses, with DENV2 most commonly been associated with DHF/DSS and DENV4 the least likely to cause the more serious infections, but all serotypes can cause all of the conditions.
Because of the nature of dengue virus pathogenesis, a tetravalent vaccine effective against all four dengue virus serotypes is urgently needed. Vaccines which induce weak immune responses below protective levels over time are not acceptable because of the severe consequences of secondary DENV infections. Efforts to develop a dengue vaccine have encompassed live attenuated virus vaccines, inactivated virus vaccines, subunit vaccines and DNA vaccines. Vaccines of each type are currently or have been subjected to clinical trials, but none has yet been approved for use. Travelers to affected regions should take precautions against being bitten by mosquitos, use insect repellent day and night and check that hotels provide mosquito nets. Just another joy of those long-haul holidays.
CDC: Dengue Fever
Global Spread and Persistence of Dengue. Ann Rev Microbiol Apr 22 2008
Prospects for a dengue virus vaccine. Nature Reviews Microbiology 2007 5: 518-528
Related:
- Pathogenic Flaviviruses
- Dengue virus infection activates the unfolded protein response
- Changing patterns of chikungunya virus
- Yellow Fever – Out of Africa
Tags: Biology, Emerging disease, Environment, Health, Medicine, Microbiology, Podcast, Science, Vaccines, Virology
I’m in guayabitos about one hour north of puerto vallarta, their is about 50 people including my mother and oncle that Iknow about that got the virus and are being treated by the local clinic I ve been told their is about 1000 more being treated and some that are in puerto vallarta hospital being treated some one should look into this before it becomes an out break