article = {CEI-2020-2-105}
title = {COVID-19 Virus Infection and Transmission are Observably Less in Highly Dengue-Endemic Countries: Is Pre-Exposure to Dengue Virus Protective Against COVID-19 Severity and Mortality? Will the Reverse Scenario Be True?}
journal = {Clinical and Experimental Investigations}
year = {2020}
issn = {2674-5054}
doi = {http://dx.doi.org/10.31487/j.CEI.2020.02.05}
url = {https://www.sciencerepository.org/covid-19-virus-infection-and-transmission-are-observably-less-in-highly_CEI-2020-2-105 
author = {Soumi  Sukla,Subhajit Biswas,}
keywords = {Dengue, COVID-19, SARS-CoV-2, epidemiology, infection, mortality, cross-protection, dengue vaccine, COVID vaccine, false-positive, antibody tests}
abstract ={Global severity maps of ongoing dengue epidemic and COVID-19 pandemic do not tend to overlap.
Countries with high dengue endemicity (>1.5 million cases/year) are observably less hit by COVID-19 in
terms of infection, transmission and mortality. Based on non-overlap of dengue and COVID-19 severity
maps in general and increasing evidences of SARS-CoV-2 false-positivity in dengue antibody tests, we
wonder whether regular pre-exposure to dengue virus (DENV) in highly dengue endemic countries is
providing some extent of protection against COVID-19 severity. We also wondered whether immunization
of susceptible populations in dengue non-endemic countries (e.g. Europe and North America) with available
live-attenuated dengue vaccines, will cue the anti-viral immune response to thwart COVID-19. Risk of
developing post-vaccination antibody-dependent enhancement (ADE) is low as dengue is not endemic in
the aforesaid regions. Understanding the consequences of dengue and COVID-19 co-endemicity in the
upcoming days is another area of huge concern. Although, it appears that dengue-induced immunity is
‘thwarting’ COVID-19, it is not clear whether conversely, COVID-19 convalescent individuals will also be
resistant to future dengue attacks. On the contrary, such individuals may show higher susceptibility to
DENV due to ADE caused by cross-reactive COVID-19 antibodies. The latter may bind to DENV without
neutralizing the virus; instead, such antibodies may facilitate cellular entry of DENV by means of their Fcregions attached to the susceptible cells. This possibility also cautions against complications that may arise
on implementing SARS-CoV-2 vaccinations in highly dengue endemic countries.}