New evidence of the development of dengue hemorrhagic fever during the dengue 3 epidemic in Cuba

For the first time this paper defines some of the factors involved in the development of dengue hemorrhagic fever during the dengue-3 epidemic in Cuba. The secondary infection is confirmed to be the most important risk factor in that epidemic, after 24 years of the primary infection with dengue-1, in contrast to the infection sequence dengue2/dengue-3 that showed no relationship. Tertiary infection was also related to the development of dengue hemorrhagic fever. The neutralizing antibody titers were different for strains of dengue-3 of the same genotype in a panel of sera of late convalescent patients with both clinical epidemic conditions. Viremia was longer in the primary than in secondary infection; the first neutralizing antibodies were not detected during acute phase, while in the secondary infection the neutralizing antibodies were detected after the fifth day, coinciding with the decline of the viremia. In general, neutralizing antibodies reached lower levels in dengue fever patients, compared to those who developed dengue hemorrhagic fever.