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DENGUE HEMORRHAGIC FEVER CAUSED BY SEQUENTIAL DENGUE 1–3 VIRUS INFECTIONS OVER A LONG TIME INTERVAL: HAVANA EPIDEMIC, 2001–2002

MAYLING ALVAREZDepartment of Virology, Pan American Health Organization/World Health Organization Collaborating Center for the Study of Dengue and its Vector, Department of Virology, Pedro Kourí Tropical Medicine Institute, Havana, Cuba; Pediatric Dengue Vaccine Initiative, Bethesda, Maryland

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ROSMARI RODRIGUEZ-ROCHEDepartment of Virology, Pan American Health Organization/World Health Organization Collaborating Center for the Study of Dengue and its Vector, Department of Virology, Pedro Kourí Tropical Medicine Institute, Havana, Cuba; Pediatric Dengue Vaccine Initiative, Bethesda, Maryland

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LÍDICE BERNARDODepartment of Virology, Pan American Health Organization/World Health Organization Collaborating Center for the Study of Dengue and its Vector, Department of Virology, Pedro Kourí Tropical Medicine Institute, Havana, Cuba; Pediatric Dengue Vaccine Initiative, Bethesda, Maryland

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SUSANA VÁZQUEZDepartment of Virology, Pan American Health Organization/World Health Organization Collaborating Center for the Study of Dengue and its Vector, Department of Virology, Pedro Kourí Tropical Medicine Institute, Havana, Cuba; Pediatric Dengue Vaccine Initiative, Bethesda, Maryland

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LUIS MORIERDepartment of Virology, Pan American Health Organization/World Health Organization Collaborating Center for the Study of Dengue and its Vector, Department of Virology, Pedro Kourí Tropical Medicine Institute, Havana, Cuba; Pediatric Dengue Vaccine Initiative, Bethesda, Maryland

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DANIEL GONZALEZDepartment of Virology, Pan American Health Organization/World Health Organization Collaborating Center for the Study of Dengue and its Vector, Department of Virology, Pedro Kourí Tropical Medicine Institute, Havana, Cuba; Pediatric Dengue Vaccine Initiative, Bethesda, Maryland

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OSVALDO CASTRODepartment of Virology, Pan American Health Organization/World Health Organization Collaborating Center for the Study of Dengue and its Vector, Department of Virology, Pedro Kourí Tropical Medicine Institute, Havana, Cuba; Pediatric Dengue Vaccine Initiative, Bethesda, Maryland

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GUSTAVO KOURIDepartment of Virology, Pan American Health Organization/World Health Organization Collaborating Center for the Study of Dengue and its Vector, Department of Virology, Pedro Kourí Tropical Medicine Institute, Havana, Cuba; Pediatric Dengue Vaccine Initiative, Bethesda, Maryland

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SCOTT B. HALSTEADDepartment of Virology, Pan American Health Organization/World Health Organization Collaborating Center for the Study of Dengue and its Vector, Department of Virology, Pedro Kourí Tropical Medicine Institute, Havana, Cuba; Pediatric Dengue Vaccine Initiative, Bethesda, Maryland

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MARIA G. GUZMANDepartment of Virology, Pan American Health Organization/World Health Organization Collaborating Center for the Study of Dengue and its Vector, Department of Virology, Pedro Kourí Tropical Medicine Institute, Havana, Cuba; Pediatric Dengue Vaccine Initiative, Bethesda, Maryland

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A dengue epidemic caused by dengue virus 3 (DENV-3) occurred in Cuba in 2001–2002. It included cases of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). We report neutralizing antibody studies on sera from 54 of 78 DHF/DSS patients that provide evidence of infections occurring in the sequence DENV-1 followed by DENV-3. No sera showed infection in the sequence DENV-2 followed by DENV-3. Some sera showed a pattern of infection in the sequence DENV-1 followed by DENV-2 and then DENV-3. However definitive categorization of a tertiary infection was not possible because of broadly reactive antibodies, which could have been raised by infections in the sequence DENV-1 then DENV-3.

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