{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:44:05Z","timestamp":1791333845304,"version":"4.3.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T00:00:00Z","timestamp":1726790400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To understand the dynamics of dengue disease with special reference to (1) age (2) primary\/secondary infections (3) serostatus and (4) serotypes examined during three consecutive years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>During 3 dengue seasons (2017\u201319), NS1\/IgM ELISAs were used for dengue diagnosis in one of the 15 administrative wards of Pune City, India. Predefined symptoms were recorded at the time of diagnosis\/hospitalization. IgG-capture ELISA (Panbio) was used to differentiate primary\/secondary infections. DENV serotypes were determined for 260 viral RNA-positive patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the 3 years, 3,014\/6,786 (44.4%, 41.4\u201349.9%) suspected cases were diagnosed as dengue. Use of either NS1 or IgM would have missed 25.5% or 43% of the confirmed dengue cases, respectively. Notably, a higher proportion of secondary dengue cases remained mild while a substantial proportion of primary infections developed warning signs. The symptoms among Dengue\/non-dengue patients and primary\/secondary infections varied and influenced by age and serostatus. The number and proportion of dengue serotypes varied yearly. A remarkable decline in dengue cases was observed during the COVID-19 pandemic years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A substantial proportion of primary and secondary dengue patients progress to warning signs\/severity or mild infection respectively, underscoring the possible role of non-ADE mechanisms in causing severe dengue that requires hospitalization. Both NS1 and IgM should be used for efficient diagnosis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1354510","type":"journal-article","created":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T04:35:41Z","timestamp":1726806941000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Dengue in Pune city, India (2017\u20132019): a comprehensive 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