Dengue fever risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Living or traveling to a region of the world where the infection is endemic is a risk factor for the disease. The presence of water-holding containers in and around the home needed for the mosquito's to complete their development sustains the reservoir for disease and is a risk factor. Risk factors for severe disease include being a neonate or young child, female sex, high body mass index, viral load, genetic polymorphisms and previous infection with DENV-1 if the patient contracts DENV-2 or Denv-3. Diabetes and asthma are risk factors for fatal disease.

Standing Water

The presence of water-holding containers in and around the home needed for the mosquito's to complete their development sustains the reservoir for disease and is a risk factor.

Geographic Risk Factors

People who travel to high-risk areas including:

• Indonesian archipelago into northeastern Australia
• South and Central America
• Southeast Asia
• Sub-Saharan Africa

Risk Factors for Secondary Infection

Although there is no commercially available vaccine for Dengue fever, it is notable that infection with one serotype is thought to produce lifelong immunity to that type, but only short term protection against the other three. Unfortunately, the risk of severe disease from secondary infection actually increases if someone previously exposed to serotype DENV-1 contracts serotype DENV-2 or DENV-3, or if someone previously exposed to DENV-3 acquires DENV-2.

Risk Factors for Severe Disease

Severe disease is more common in babies and young children, and in contrast to many other infections it is more common in children that are relatively well nourished. Other risk factors for severe disease include female sex, high body mass index, and viral load. While each serotype can cause the full spectrum of disease, virus strain is a risk factor. Infection with one serotype is thought to produce lifelong immunity to that type, but only short term protection against the other three. The risk of severe disease from secondary infection increases if someone previously exposed to serotype DENV-1 contracts serotype DENV-2 or DENV-3, or if someone previously exposed to DENV-3 acquires DENV-2. Dengue can be life-threatening in people with chronic diseases such as diabetes and asthma.

Polymorphisms in particular genes have been linked with an increased risk of severe dengue complications. Examples include the genes coding for the proteins known as TNF-α, mannan-binding lectin, CTLA-4, TGF-β, DC-SIGN, PLCE1, and particular forms of human leukocyte antigen from gene variations of HLA-B. A common genetic abnormality in Africans, known as glucose-6-phosphate dehydrogenase deficiency, appears to increase the risk. Polymorphisms in the genes for the vitamin D receptorand FcγR seem to offer protection against severe disease in secondary dengue infection.