{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:31:50Z","timestamp":1760401910678,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T00:00:00Z","timestamp":1579824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Zika virus (ZIKV) is a mosquito-borne flavivirus associated with a febrile illness as well as severe complications, including microcephaly and Guillain-Barr\u00e9 Syndrome. Antibody cross-reactivity between flaviviruses has been documented, and in regions where ZIKV is circulating, dengue virus (DENV) is also endemic, leaving the potential that previous exposure to DENV could alter clinical features of ZIKV infection. To investigate this, we performed a retrospective case-control study in which we compared Canadian travellers who had been infected with ZIKV and had serological findings indicating previous DENV or other flavivirus exposure (n = 16) to those without any previous exposure (n = 44). Patient samples were collected between February 2016 and September 2017 and submitted to Public Health Ontario for testing. ZIKV infection was determined using real-time RT-PCR and antibodies against DENV were identified by the plaque-reduction neutralization test. The mean time from symptom onset to sample collection was 5 days for both groups; the magnitude of viremia was not statistically different (Ct values: 35.6 vs. 34.9, p-value = 0.2). Clinical scores were also similar. Our findings indicate that previous DENV or other flavivirus exposure did not result in greater viremia or a higher illness score.<\/jats:p>","DOI":"10.3390\/v12020140","type":"journal-article","created":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T11:01:00Z","timestamp":1579863660000},"page":"140","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Presence of Flavivirus Antibodies Does Not Lead to a Greater Number of Symptoms in a Small Cohort of Canadian Travelers Infected with Zika Virus"],"prefix":"10.3390","volume":"12","author":[{"given":"Robert A.","family":"Kozak","sequence":"first","affiliation":[{"name":"Division of Microbiology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee W.","family":"Goneau","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, ON M5G 1V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cedric","family":"DeLima","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, ON M5G 1V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Varsaneux","sequence":"additional","affiliation":[{"name":"Government of Canada, Ottawa, ON K1Z 8R9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"AliReza","family":"Eshaghi","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, ON M5G 1V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Kristjanson","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, ON M5G 1V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romy","family":"Olsha","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, ON M5G 1V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Safronetz","sequence":"additional","affiliation":[{"name":"Special Pathogens Program, National Microbiology Laboratory, Winnipeg, MB R3E 3R2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Perusini","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, ON M5G 1V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Frantz","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, ON M5G 1V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan B.","family":"Gubbay","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada"},{"name":"Public Health Ontario, Toronto, ON M5G 1V2, Canada"},{"name":"Hospital for Sick Children, Toronto, ON M5G 1V2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,24]]},"reference":[{"key":"ref_1","first-page":"294","article-title":"Zika Virus","volume":"375","author":"Kass","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.2471\/BLT.19.020119","article-title":"Zika: The continuing threat","volume":"97","year":"2019","journal-title":"Bull. World Health Organ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"671","DOI":"10.5811\/westjem.2016.9.30904","article-title":"Dengue, Zika and Chikungunya: Emerging Arboviruses in the New World","volume":"17","author":"Patterson","year":"2016","journal-title":"West J. Emerg. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3389\/fcimb.2018.00044","article-title":"Antibody-Dependent Enhancement and Zika: Real Threat or Phantom Menace?","volume":"8","author":"Saiz","year":"2018","journal-title":"Front Cell Infect. Microbiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1126\/science.aan6836","article-title":"Antibody-dependent enhancement of severe dengue disease in humans","volume":"358","author":"Katzelnick","year":"2017","journal-title":"Science"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1093\/infdis\/jiw377","article-title":"Zika Virus-Induced Antibody Response Enhances Dengue Virus Serotype 2 Replication In Vitro","volume":"214","author":"Kawiecki","year":"2016","journal-title":"J. Infect. Dis."},{"doi-asserted-by":"crossref","unstructured":"Priyamvada, L., Quicke, K.M., Hudson, W.H., Onlamoon, N., Sewatanon, J., Edupganti, S., Pattanapanyasat, K., Chokephaibulkit, K., Mulligan, M., and Wilson, C. (2016). Human antibody responses after dengue virus infection are highly cross-reactive to Zika virus. Proc. Natl. Acad. Sci. USA.","key":"ref_7","DOI":"10.1073\/pnas.1607931113"},{"doi-asserted-by":"crossref","unstructured":"Rogers, T.F., Goodwin, E.C., Briney, B., Sok, D., Beutler, N., Strubel, A., Nedellec, R., Le, K., Brown, M.E., and Burton, D.R. (2017). Zika virus activates de novo and cross-reactive memory B cell responses in dengue-experienced donors. Sci. Immunol., 2.","key":"ref_8","DOI":"10.1126\/sciimmunol.aan6809"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1126\/science.aal4365","article-title":"Enhancement of Zika virus pathogenesis by preexisting antiflavivirus immunity","volume":"356","author":"Bardina","year":"2017","journal-title":"Science"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10498","DOI":"10.1038\/s41598-017-10901-1","article-title":"Prior Exposure to Zika Virus Significantly Enhances Peak Dengue-2 Viremia in Rhesus Macaques","volume":"7","author":"George","year":"2017","journal-title":"Sci. Rep."},{"doi-asserted-by":"crossref","unstructured":"Kam, Y.W., Lee, C.Y., Teo, T.H., Howland, S.W., Amrun, S.N., Lum, F.M., See, P., Kng, N.Q., Huber, R.G., and Xu, M.H. (2017). Cross-reactive dengue human monoclonal antibody prevents severe pathologies and death from Zika virus infections. JCI Insight, 2.","key":"ref_11","DOI":"10.1172\/jci.insight.92428"},{"doi-asserted-by":"crossref","unstructured":"McCracken, M.K., Gromowski, G.D., Friberg, H.L., Lin, X., Abbink, P., de La Barrera, R., Eckles, K.H., Garver, L.S., Boyd, M., and Jetton, D. (2017). Impact of prior flavivirus immunity on Zika virus infection in rhesus macaques. PLoS Pathog., 13.","key":"ref_12","DOI":"10.1371\/journal.ppat.1006487"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1038\/ni.3515","article-title":"Dengue virus sero-cross-reactivity drives antibody-dependent enhancement of infection with zika virus","volume":"17","author":"Dejnirattisai","year":"2016","journal-title":"Nat. Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1128\/JCM.00279-16","article-title":"Zika Virus: Diagnostics for an Emerging Pandemic Threat","volume":"54","author":"Waggoner","year":"2016","journal-title":"J. Clin. Microbiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"543","DOI":"10.15585\/mmwr.mm6521e1","article-title":"Interim Guidance for Interpretation of Zika Virus Antibody Test Results","volume":"65","author":"Rabe","year":"2016","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1128\/JCM.02153-16","article-title":"Evaluation of Altona Diagnostics RealStar Zika Virus Reverse Transcription-PCR Test Kit for Zika Virus PCR Testing","volume":"55","author":"Lombos","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/S1995-7645(12)60055-8","article-title":"Multiplex real-time RT-PCR for detecting chikungunya virus and dengue virus","volume":"5","author":"Pongsiri","year":"2012","journal-title":"Asian Pac. J. Trop. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1099\/0022-1317-70-1-37","article-title":"Antigenic relationships between flaviviruses as determined by cross-neutralization tests with polyclonal antisera","volume":"70","author":"Calisher","year":"1989","journal-title":"J. Gen. Virol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4421","DOI":"10.1172\/JCI83162","article-title":"Ebola viral load at diagnosis associates with patient outcome and outbreak evolution","volume":"125","author":"Caleo","year":"2015","journal-title":"J. Clin. Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jcv.2016.06.011","article-title":"Viral load kinetics of Zika virus in plasma, urine and saliva in a couple returning from Martinique, French West Indies","volume":"82","author":"Fourcade","year":"2016","journal-title":"J. Clin. Virol."},{"doi-asserted-by":"crossref","unstructured":"Read, J.S., Torres-Velasquez, B., Lorenzi, O., Rivera Sanchez, A., Torres-Torres, S., Rivera, L.V., Capre-Franceschi, S.M., Garcia-Gubern, C., Munoz-Jordan, J., and Santiago, G.A. (2018). Symptomatic Zika Virus Infection in Infants, Children, and Adolescents Living in Puerto Rico. JAMA Pediatr.","key":"ref_21","DOI":"10.1001\/jamapediatrics.2018.0870"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jcv.2017.09.002","article-title":"Clinical, laboratory and virological data from suspected ZIKV patients in an endemic arbovirus area","volume":"96","author":"Colombo","year":"2017","journal-title":"J. Clin. Virol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/0035-9203(52)90043-6","article-title":"Zika virus. II. Pathogenicity and physical properties","volume":"46","author":"Dick","year":"1952","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/0035-9203(52)90042-4","article-title":"Zika virus. I. Isolations and serological specificity","volume":"46","author":"Dick","year":"1952","journal-title":"Trans. R. Society Trop. Med. Hyg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1093\/cid\/cix558","article-title":"Viral Load and Cytokine Response Profile Does Not Support Antibody-Dependent Enhancement in Dengue-Primed Zika Virus-Infected Patients","volume":"65","author":"Terzian","year":"2017","journal-title":"Clin. Infect. Dis."},{"doi-asserted-by":"crossref","unstructured":"Santiago, G.A., Sharp, T.M., Rosenberg, E., Sosa Cardona, I.I., Alvarado, L., Paz-Bailey, G., and Munoz-Jordan, J.L. (2019). Prior Dengue Virus Infection Is Associated With Increased Viral Load in Patients Infected With Dengue but Not Zika Virus. Open Forum Infect. Dis., 6.","key":"ref_26","DOI":"10.1093\/ofid\/ofz320"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1056\/NEJMra1602113","article-title":"El virus del Zika","volume":"374","author":"Petersen","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1093\/cid\/cix472","article-title":"Maternal Zika Virus Disease Severity, Virus Load, Prior Dengue Antibodies, and Their Relationship to Birth Outcomes","volume":"65","author":"Halai","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.3201\/eid2508.190113","article-title":"Cross-Protection of Dengue Virus Infection against Congenital Zika Syndrome, Northeastern Brazil","volume":"25","author":"Pedroso","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.jinf.2017.03.007","article-title":"Clinical features of patients with Zika and dengue virus co-infection in Singapore","volume":"74","author":"Chia","year":"2017","journal-title":"J. Infect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"780","DOI":"10.4269\/ajtmh.18-0237","article-title":"Zika Virus and the World Health Organization Criteria for Determining Recent Infection Using Plaque Reduction Neutralization Testing","volume":"99","author":"Ward","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"116","DOI":"10.3855\/jidc.8217","article-title":"Zika virus outbreak in Brazil","volume":"10","author":"Heukelbach","year":"2016","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"15674","DOI":"10.1038\/ncomms15674","article-title":"Zika virus pathogenesis in rhesus macaques is unaffected by pre-existing immunity to dengue virus","volume":"8","author":"Pantoja","year":"2017","journal-title":"Nat. Commun."},{"doi-asserted-by":"crossref","unstructured":"Montoya, M., Gresh, L., Mercado, J.C., Williams, K.L., Vargas, M.J., Gutierrez, G., Kuan, G., Gordon, A., Balmaseda, A., and Harris, E. (2013). Symptomatic versus inapparent outcome in repeat dengue virus infections is influenced by the time interval between infections and study year. PLoS Negl. Trop. Dis., 7.","key":"ref_34","DOI":"10.1371\/journal.pntd.0002357"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/12\/2\/140\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:20:35Z","timestamp":1760361635000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/12\/2\/140"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,24]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,2]]}},"alternative-id":["v12020140"],"URL":"https:\/\/doi.org\/10.3390\/v12020140","relation":{},"ISSN":["1999-4915"],"issn-type":[{"type":"electronic","value":"1999-4915"}],"subject":[],"published":{"date-parts":[[2020,1,24]]}}}