Dengue in the Early Febrile Phase: Viremia and Antibody Responses

TLDR

A multicenter study began in 1994 enrolling all children with undifferentiated fever lasting less than 72 h, enrolling 189 children aged 8 months to 14 years to characterize dengue pathophysiology. Among the 189 children, 32 % (60) had dengue, 93 % of whom had secondary infections, the virus was isolated from 98 % of plasma samples, viremia correlated with temperature, all four serotypes were detected, and the data confirm that all serotypes can cause dengue hemorrhagic fever with viremia peaking during fever and declining as fever resolves.

Abstract

A multicenter effort was begun in 1994 to characterize the pathophysiology of dengue using a study design that minimized patient selection bias by offering enrollment to all children with undifferentiated fever for <72 h. In the first year, 189 children were enrolled (age range, 8 months to 14 years). Thirty-two percent of these children had dengue infections (60 volunteers). The percentage of children with a secondary dengue infection was 93%, with only 4 (7%) having a primary dengue infection. The virus isolation rate from the plasma of children with dengue was 98%. Viremia correlated highly with temperature. All four dengue virus serotypes were isolated at both study sites. This study demonstrates that all four serotypes of dengue virus can cause dengue hemorrhagic fever, that all dengue patients as defined by serology experience viremia during the febrile phase, and that as fever subsides, so does viremia.