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Risk factors for severe dengue

DENV pathogenesis remains a challenging jigsaw puzzle with many pieces missing to understand the complex interplay of viral and host factors. Despite intensive research, it is not well understood. The severity of DENV infection is modulated by multiple risk factors such as age (83, 84), the genetic background of the host (85, 86), viral serotype (83, 87) and genotype (88, 89), and secondary DENV infection by a heterologous serotype (85, 9093). Finally, the virus serotype and genotype also influence the symptomatic picture of disease and outcome (Fig. 2). These observations were initially based on epidemiological findings, but accumulating laboratory and experimental data have contributed to the recognition of DENV virulence as an important risk factor.