Four serotypes of dengue virus (DV1-4) circulate globally, causing more human illness than any other mosquito-borne virus. DV infection results in dengue fever, an acute debilitating febrile illness, or more severe life-threatening forms of th disease. DV infection confers life-long immunity against re-infection with the same serotype, but may protect against or enhance subsequent infection with a heterologous serotype. Despite the risk and the cross-protection associated with secondary DV infections, very little is known about 2nd, 3rd, or 4th DV infections specifically, largely because cohort studies with appropriate longevity have not existed. We have a unique opportunity to leverage the ICIDR influenza cohort and existing infrastructure from previous and ongoing NIH-supported studies in Managua, Nicaragua, to extend the Pediatric Dengue Cohort Study (PDCS), now arguably the longest running continuous cohort in the dengue field. The PDCS has been ongoing since August of 2004, with high-quality laboratory, epidemiological, clinical, and operational infrastructure, together with community buy-in and support from the Nicaraguan Ministry of Health. The longevity of the cohort allows specific questions about 3rd and 4th DV infections to be addressed for the first time. The resulting data have important implications for vaccine design and understanding dengue immunopathogenesis and natural protection. We will continue to follow 3,300 children 2-14 years old in Managua and examine epidemiological, clinical, and immunological characteristics of 3rd/4th vs. 2nd DV infections. This is a unique opportunity to leverage existing research infrastructure and resources to continue a long-term prospective cohort study in Nicaragua to answer critical questions about dengue that have direct implications for vaccine development. Our data from the PDCS over the past 7 years demonstrates the feasibility of identifying sufficient repeat DV infections and obtaining the samples for Aims 1-3. The PI, Director of the National Virology Laboratory (NVL) and Director of the Nicaraguan Virology Program at the Instituto de Ciencias Sostenibles in Managua, has collaborated closely with Dr. Eva Harris at the University of California (UC), Berkeley, for over 16 years. We have preliminary data supporting all the proposed experiments and methodologies and are well- poised to perform the studies outlined. Importantly, all the proposed work will be conducted in Nicaragua, with continued scientific interaction and training with the Harris Laboratory at UC Berkeley.
Aim 1 will identify repeat DV infections in the cohort and determine risk factors for infection outcome in 3rd/4th vs. 2nd DV infections.
Aim 2 will use longitudinal statistical methods to evaluate clinical signs and symptoms associated with 3rd/4th DV infections as compared to 1st and 2nd infections.
In Aim 3, we will characterize the B cell and humoral immune response and analyze the relation of serum avidity and breadth and quality of DV-specific B cells to DV infection number and outcome.
These aims address critical concepts in the dengue field that have never been carefully characterized, and the results are highly relevant for vaccine development

Public Health Relevance

Dengue, caused by the 4 dengue virus serotypes (DV1-4), is a major and expanding public health problem worldwide;DV infection confers life-long immunity against re-infection with the same serotype, but may protect against or enhance subsequent infection with a different serotype. Despite the risk and cross-protection of secondary DV infections, very little is known about 2nd, 3rd, or 4th DV infections specifically, largely because cohort studies with appropriate longevity have not existed. We will extend the Nicaraguan Pediatric Dengue Cohort Study, arguably the longest running continuous dengue cohort, to examine epidemiological, clinical, and immunological characteristics of 3rd/4th vs. 2nd infections;thus, this is a unique opportunity to leverage existing research infrastructure and resources to continue a long-term prospective cohort study in Nicaragua in order to answer critical questions about dengue that have direct implications for vaccine development.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
5R01AI099631-03
Application #
8678834
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Cassetti, Cristina
Project Start
2012-06-28
Project End
2017-05-31
Budget Start
2014-06-01
Budget End
2015-05-31
Support Year
3
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Sustainable Sciences Institute
Department
Type
DUNS #
City
Managua
State
Country
Nicaragua
Zip Code
Katzelnick, Leah C; Gresh, Lionel; Halloran, M Elizabeth et al. (2017) Antibody-dependent enhancement of severe dengue disease in humans. Science 358:929-932
Galo, Saira Saborío; González, Karla; Téllez, Yolanda et al. (2017) Development of in-house serological methods for diagnosis and surveillance of chikungunya. Rev Panam Salud Publica 41:e56
Balmaseda, Angel; Stettler, Karin; Medialdea-Carrera, Raquel et al. (2017) Antibody-based assay discriminates Zika virus infection from other flaviviruses. Proc Natl Acad Sci U S A 114:8384-8389
Chotiwan, Nunya; Brewster, Connie D; Magalhaes, Tereza et al. (2017) Rapid and specific detection of Asian- and African-lineage Zika viruses. Sci Transl Med 9:
Waggoner, Jesse J; Gresh, Lionel; Mohamed-Hadley, Alisha et al. (2017) Characterization of Dengue Virus Infections Among Febrile Children Clinically Diagnosed With a Non-Dengue Illness, Managua, Nicaragua. J Infect Dis 215:1816-1823
Balmaseda, Angel; Gordon, Aubree; Gresh, Lionel et al. (2016) Clinical Attack Rate of Chikungunya in a Cohort of Nicaraguan Children. Am J Trop Med Hyg 94:397-9
Waggoner, Jesse J; Gresh, Lionel; Mohamed-Hadley, Alisha et al. (2016) Single-Reaction Multiplex Reverse Transcription PCR for Detection of Zika, Chikungunya, and Dengue Viruses. Emerg Infect Dis 22:1295-7
Kuan, Guillermina; Ramirez, Stephania; Gresh, Lionel et al. (2016) Seroprevalence of Anti-Chikungunya Virus Antibodies in Children and Adults in Managua, Nicaragua, After the First Chikungunya Epidemic, 2014-2015. PLoS Negl Trop Dis 10:e0004773
Waggoner, Jesse J; Gresh, Lionel; Vargas, Maria Jose et al. (2016) Viremia and Clinical Presentation in Nicaraguan Patients Infected With Zika Virus, Chikungunya Virus, and Dengue Virus. Clin Infect Dis 63:1584-1590
Waggoner, Jesse J; Balmaseda, Angel; Gresh, Lionel et al. (2016) Homotypic Dengue Virus Reinfections in Nicaraguan Children. J Infect Dis 214:986-93

Showing the most recent 10 out of 25 publications