Shifting patterns of dengue three years after Zika virus emergence in Brazil

Francesco Pinotti (), Marta Giovanetti, Maricelia Maia Lima, Erenilde Marques Cerqueira, Luiz C. J. Alcantara, Sunetra Gupta, Mario Recker and José Lourenço
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Francesco Pinotti: University of Oxford
Marta Giovanetti: Instituto Oswaldo Cruz, Fundação Oswaldo Cruz
Maricelia Maia Lima: Universidade Estadual de Feira de Santana
Erenilde Marques Cerqueira: Universidade Estadual de Feira de Santana
Luiz C. J. Alcantara: Instituto Oswaldo Cruz, Fundação Oswaldo Cruz
Sunetra Gupta: University of Oxford
Mario Recker: University of Exeter
José Lourenço: Universidade Católica Portuguesa

Nature Communications, 2024, vol. 15, issue 1, 1-10

Abstract: Abstract In 2015, the Zika virus (ZIKV) emerged in Brazil, leading to widespread outbreaks in Latin America. Following this, many countries in these regions reported a significant drop in the circulation of dengue virus (DENV), which resurged in 2018-2019. We examine age-specific incidence data to investigate changes in DENV epidemiology before and after the emergence of ZIKV. We observe that incidence of DENV was concentrated in younger individuals during resurgence compared to 2013-2015. This trend was more pronounced in Brazilian states that had experienced larger ZIKV outbreaks. Using a mathematical model, we show that ZIKV-induced cross-protection alone, often invoked to explain DENV decline across Latin America, cannot explain the observed age-shift without also assuming some form of disease enhancement. Our results suggest that a sudden accumulation of population-level immunity to ZIKV could suppress DENV and reduce the mean age of DENV incidence via both protective and disease-enhancing interactions.

Date: 2024
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DOI: 10.1038/s41467-024-44799-x

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