{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T06:59:43Z","timestamp":1793084383523,"version":"4.5.0"},"reference-count":52,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T00:00:00Z","timestamp":1597881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008463","name":"Universitas Airlangga","doi-asserted-by":"publisher","award":["965\/UN3.14\/LT\/2019"],"award-info":[{"award-number":["965\/UN3.14\/LT\/2019"]}],"id":[{"id":"10.13039\/501100008463","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Outbreaks of dengue virus (DENV) in Indonesia have been mainly caused by the DENV serotype-1; -2; or -3. The DENV-4 was the least-reported serotype in Indonesia during the last five decades. We recently conducted a molecular epidemiology study of dengue in the Jember regency, East Java province, Indonesia. Dengue is endemic in the region and outbreaks occur annually. We investigated the clinical characteristics and etiology of dengue-like febrile illness in this regency to understand the disease dynamics. A total of 191 patients with clinical symptoms similar to dengue were recruited during an 11-month study in 2019\u20132020. Children accounted for the majority of cases and dengue burden was estimated in 41.4% of the cases based on NS1 antigen, viral RNA, and IgG\/IgM antibody detection with the majority (73.4%) being primary infections. Secondary infection was significantly associated with a higher risk of severe dengue manifestation. All four DENV serotypes were detected in Jember. Strikingly, we observed the predominance of DENV-4, followed by DENV-3, DENV-1, and DENV-2. Genotype determination using Envelope gene sequence revealed the classification into Genotype I, Cosmopolitan Genotype, Genotype I, and Genotype II for DENV-1, -2, -3, and -4, respectively. The predominance of DENV-4 in Jember may be associated with a new wave of DENV infections and spread in a non-immune population lacking a herd-immunity to this particular serotype.<\/jats:p>","DOI":"10.3390\/v12090913","type":"journal-article","created":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T09:35:31Z","timestamp":1597916131000},"page":"913","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Dengue Virus Serotype 4 Is Responsible for the Outbreak of Dengue in East Java City of Jember, Indonesia"],"prefix":"10.3390","volume":"12","author":[{"given":"Aryati","family":"Aryati","sequence":"first","affiliation":[{"name":"Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia"},{"name":"Institute of Tropical Diseases, Universitas Airlangga, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Billy J.","family":"Wrahatnala","sequence":"additional","affiliation":[{"name":"Master Program of Tropical Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2378-2386","authenticated-orcid":false,"given":"Benediktus","family":"Yohan","sequence":"additional","affiliation":[{"name":"Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May","family":"Fanny","sequence":"additional","affiliation":[{"name":"Clinical Pathology Sub-Specialization Program, Universitas Airlangga, Surabaya 60286, Indonesia"},{"name":"Department of Clinical Pathology, Faculty of Medicine, Universitas Ciputra, Surabaya 60219, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faradila K. N.","family":"Hakim","sequence":"additional","affiliation":[{"name":"Master Program of Tropical Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eka Putri","family":"Sunari","sequence":"additional","affiliation":[{"name":"Clinical Pathology Specialization Program, Universitas Airlangga, Surabaya 60286, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelly","family":"Zuroidah","sequence":"additional","affiliation":[{"name":"Clinical Pathology Specialization Program, Universitas Airlangga, Surabaya 60286, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puspa","family":"Wardhani","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia"},{"name":"Institute of Tropical Diseases, Universitas Airlangga, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marsha S.","family":"Santoso","sequence":"additional","affiliation":[{"name":"Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominicus","family":"Husada","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8177-5881","authenticated-orcid":false,"given":"Ali","family":"Rohman","sequence":"additional","affiliation":[{"name":"Department of Chemistry, Faculty of Science and Technology, Universitas Airlangga, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siti Nadia","family":"Tarmizi","sequence":"additional","affiliation":[{"name":"Directorate of Vector-Borne and Zoonotic Disease, Ministry of Health of Indonesia, Jakarta 12950, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0252-6594","authenticated-orcid":false,"given":"Justus T. O.","family":"Sievers","sequence":"additional","affiliation":[{"name":"Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0986-2590","authenticated-orcid":false,"given":"R. Tedjo","family":"Sasmono","sequence":"additional","affiliation":[{"name":"Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"45505","DOI":"10.1038\/srep45505","article-title":"Global evolutionary history and spatio-temporal dynamics of dengue virus type 2","volume":"7","author":"Wei","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1128\/CMR.3.4.376","article-title":"The dengue viruses","volume":"3","author":"Henchal","year":"1990","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1038\/nrmicro2460","article-title":"Dengue: A continuing global threat","volume":"8","author":"Guzman","year":"2010","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1128\/CMR.11.3.480","article-title":"Dengue and dengue hemorrhagic fever","volume":"11","author":"Gubler","year":"1998","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_5","unstructured":"World Health Organization (2011). Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever, WHO Regional Office for South-East Asia."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/S1567-1348(03)00004-2","article-title":"The origin, emergence and evolutionary genetics of dengue virus","volume":"3","author":"Holmes","year":"2003","journal-title":"Infect. Genet. Evol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/S0065-3527(03)59009-1","article-title":"Microevolution and virulence of dengue viruses","volume":"59","year":"2003","journal-title":"Adv. Virus Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.meegid.2009.02.003","article-title":"Molecular Evolution of Dengue Viruses: Contributions of Phylogenetics to Understanding the History and Epidemiology of the Preeminent Arboviral Disease","volume":"9","author":"Weaver","year":"2009","journal-title":"Infect. Genet. Evol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sang, S., Liu-Helmersson, J., Quam, M.B.M., Zhou, H., Guo, X., Wu, H., and Liu, Q. (2019). The evolutionary dynamics of DENV 4 genotype I over a 60-year period. PLoS Negl. Trop. Dis., 13.","DOI":"10.1371\/journal.pntd.0007592"},{"key":"ref_10","unstructured":"Sumarmo (1987). Dengue haemorrhagic fever in Indonesia. Southeast Asian J. Trop. Med. Public Health, 18, 269\u2013274."},{"key":"ref_11","unstructured":"(2019). Ministry of Health of the Republic of Indonesia Indonesia Health Profile 2018."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.meegid.2014.09.002","article-title":"Continuous dengue type 1 virus genotype shifts followed by co-circulation, clade shifts and subsequent disappearance in Surabaya, Indonesia, 2008\u20132013","volume":"28","author":"Kotaki","year":"2014","journal-title":"Infect. Genet. Evol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.meegid.2015.11.002","article-title":"Divergence of the dengue virus type 2 Cosmopolitan genotype associated with two predominant serotype shifts between 1 and 2 in Surabaya, Indonesia, 2008\u20132014","volume":"37","author":"Kotaki","year":"2016","journal-title":"Infect. Genet. Evol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Wardhani, P., Aryati, A., Yohan, B., Trimarsanto, H., Setianingsih, T.Y., Puspitasari, D., Arfijanto, M.V., Bramantono, B., Suharto, S., and Sasmono, R.T. (2017). Clinical and virological characteristics of dengue in Surabaya, Indonesia. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178443"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"8127093","DOI":"10.1155\/2018\/8127093","article-title":"Phylogenetic Analysis of Dengue Virus in Bangkalan, Madura Island, East Java Province, Indonesia","volume":"2018","author":"Sucipto","year":"2018","journal-title":"J. Trop. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jviromet.2008.07.021","article-title":"Molecular genotyping of dengue viruses by phylogenetic analysis of the sequences of individual genes","volume":"154","author":"Klungthong","year":"2008","journal-title":"J. Virol. Methods"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.meegid.2015.03.006","article-title":"Genomic analysis and growth characteristic of dengue viruses from Makassar, Indonesia","volume":"32","author":"Sasmono","year":"2015","journal-title":"Infect. Genet. Evol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.celrep.2018.10.006","article-title":"Genetic Variation between Dengue Virus Type 4 Strains Impacts Human Antibody Binding and Neutralization","volume":"25","author":"Gallichotte","year":"2018","journal-title":"Cell Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e2037","DOI":"10.1002\/rmv.2037","article-title":"Dengue viruses circulating in Indonesia: A systematic review and phylogenetic analysis of data from five decades","volume":"29","author":"Harapan","year":"2019","journal-title":"Rev. Med. Virol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1007\/s11262-017-1474-7","article-title":"Phylogenetic and evolutionary analyses of dengue viruses isolated in Jakarta, Indonesia","volume":"53","author":"Lestari","year":"2017","journal-title":"Virus Genes"},{"key":"ref_21","first-page":"53","article-title":"Characterization of dengue virus serotype 4 infection in Jakarta, Indonesia","volume":"45","author":"Dewi","year":"2014","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Harapan, H., Michie, A., Mudatsir, M., Nusa, R., Yohan, B., Wagner, A.L., Sasmono, R.T., and Imrie, A. (2019). Chikungunya virus infection in Indonesia: A systematic review and evolutionary analysis. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-3857-y"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.1038\/emi.2017.42","article-title":"Humoral cross-reactivity between Zika and dengue viruses: Implications for protection and pathology","volume":"6","author":"Priyamvada","year":"2017","journal-title":"Emerg. Microbes Infect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1128\/JCM.36.1.234-238.1998","article-title":"Evaluation of a Rapid Immunochromatographic Test for Diagnosis of Dengue Virus Infection","volume":"36","author":"Vaughn","year":"1998","journal-title":"J. Clin. Microbiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ijid.2018.11.050","article-title":"Endemicity of Zika virus in Indonesia: Serological evidence in pediatric population","volume":"79","author":"Sasmono","year":"2019","journal-title":"Int. J. Infect. Dis."},{"key":"ref_26","unstructured":"BPS-Statistics of Jember Regency (2020). Jember Regency in Figures 2020 Delivering Data to Inform Development Planning."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1128\/JVI.72.1.73-83.1998","article-title":"Phylogeny of the genus Flavivirus","volume":"72","author":"Kuno","year":"1998","journal-title":"J. Virol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1093\/molbev\/msy096","article-title":"MEGA X: Molecular Evolutionary Genetics Analysis across Computing Platforms","volume":"35","author":"Kumar","year":"2018","journal-title":"Mol. Biol. Evol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1006\/viro.2002.1686","article-title":"Diversity and evolution of the envelope gene of dengue virus type 1","volume":"303","author":"Goncalvez","year":"2002","journal-title":"Virology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1006\/viro.2002.1447","article-title":"Phylogenetic relationships and differential selection pressures among genotypes of dengue-2 virus","volume":"298","author":"Twiddy","year":"2002","journal-title":"Virology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1099\/0022-1317-75-1-65","article-title":"Molecular evolution and epidemiology of dengue-3 viruses","volume":"75","author":"Lanciotti","year":"1994","journal-title":"J. Gen. Virol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.1099\/0022-1317-78-9-2279","article-title":"Molecular evolution and phylogeny of dengue-4 viruses","volume":"78","author":"Lanciotti","year":"1997","journal-title":"J. Gen. Virol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bouckaert, R., Vaughan, T.G., Barido-Sottani, J., Duch\u00eane, S., Fourment, M., Gavryushkina, A., Heled, J., Jones, G., K\u00fchnert, D., and De Maio, N. (2019). BEAST 2.5: An advanced software platform for Bayesian evolutionary analysis. PLoS Comput. Biol., 15.","DOI":"10.1371\/journal.pcbi.1006650"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.meegid.2011.12.011","article-title":"Comparative evolutionary epidemiology of dengue virus serotypes","volume":"12","author":"Costa","year":"2012","journal-title":"Infect. Genet. Evol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s12985-019-1202-0","article-title":"Multiple introductions of dengue virus strains contribute to dengue outbreaks in East Kalimantan, Indonesia, in 2015\u20132016","volume":"16","author":"Sasmono","year":"2019","journal-title":"Virol. J."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Masyeni, S., Yohan, B., Somia, I.K.A., Myint, K.S.A., and Sasmono, R.T. (2018). Dengue infection in international travellers visiting Bali, Indonesia. J. Travel. Med., 25.","DOI":"10.1093\/jtm\/tay061"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Utama, I.M.S., Lukman, N., Sukmawati, D.D., Alisjahbana, B., Alam, A., Murniati, D., Utama, I.M.G.D.L., Puspitasari, D., Kosasih, H., and Laksono, I. (2019). Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study. PLoS Negl. Trop. Dis., 13.","DOI":"10.1371\/journal.pntd.0007785"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/20477724.2016.1184864","article-title":"The molecular and clinical features of dengue during outbreak in Jambi, Indonesia in 2015","volume":"110","author":"Haryanto","year":"2016","journal-title":"Pathog. Glob. Health"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Kusmintarsih, E.S., Hayati, R.F., Turnip, O.N., Yohan, B., Suryaningsih, S., Pratiknyo, H., Denis, D., and Sasmono, R.T. (2017). Molecular characterization of dengue viruses isolated from patients in Central Java, Indonesia. J. Infect. Public Health.","DOI":"10.1016\/j.jiph.2017.09.019"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Megawati, D., Masyeni, S., Yohan, B., Lestarini, A., Hayati, R.F., Meutiawati, F., Suryana, K., Widarsa, T., Budiyasa, D.G., and Budiyasa, N. (2017). Dengue in Bali: Clinical characteristics and genetic diversity of circulating dengue viruses. PLoS Negl. Trop. Dis., 11.","DOI":"10.1371\/journal.pntd.0005483"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"733","DOI":"10.3855\/jidc.3959","article-title":"Molecular surveillance of dengue in Sukabumi, West Java province, Indonesia","volume":"8","author":"Nusa","year":"2014","journal-title":"J. Infect. Dev. Ctries"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Kosasih, H., de Mast, Q., Widjaja, S., Sudjana, P., Antonjaya, U., Ma\u2019roef, C., Riswari, S.F., Porter, K.R., Burgess, T.H., and Alisjahbana, B. (2013). Evidence for endemic chikungunya virus infections in Bandung, Indonesia. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002483"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Capeding, M.R., Chua, M.N., Hadinegoro, S.R., Hussain, I.I.H.M., Nallusamy, R., Pitisuttithum, P., Rusmil, K., Thisyakorn, U., Thomas, S.J., and Huu Tran, N. (2013). Dengue and other common causes of acute febrile illness in Asia: An active surveillance study in children. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002331"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1007\/s00705-013-1645-3","article-title":"Secondary infection as a risk factor for dengue hemorrhagic fever\/dengue shock syndrome: An historical perspective and role of antibody-dependent enhancement of infection","volume":"158","author":"Guzman","year":"2013","journal-title":"Arch. Virol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1002\/jmv.10478","article-title":"Correlation between increased platelet-associated IgG and thrombocytopenia in secondary dengue virus infections","volume":"71","author":"Oishi","year":"2003","journal-title":"J. Med. Virol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.meegid.2007.12.005","article-title":"Periodic re-emergence of endemic strains with strong epidemic potential-a proposed explanation for the 2004 Indonesian dengue epidemic","volume":"8","author":"Ong","year":"2008","journal-title":"Infect. Genet. Evol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Fahri, S., Yohan, B., Trimarsanto, H., Sayono, S., Hadisaputro, S., Dharmana, E., Syafruddin, D., and Sasmono, R.T. (2013). Molecular Surveillance of Dengue in Semarang, Indonesia Revealed the Circulation of an Old Genotype of Dengue Virus Serotype-1. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002354"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Forshey, B.M., Reiner, R.C., Olkowski, S., Morrison, A.C., Espinoza, A., Long, K.C., Vilcarromero, S., Casanova, W., Wearing, H.J., and Halsey, E.S. (2016). Incomplete Protection against Dengue Virus Type 2 Re-infection in Peru. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004398"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1093\/infdis\/jiw099","article-title":"Homotypic Dengue Virus Reinfections in Nicaraguan Children","volume":"214","author":"Waggoner","year":"2016","journal-title":"J. Infect. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Soo, K.M., Khalid, B., Ching, S.M., and Chee, H.Y. (2016). Meta-Analysis of Dengue Severity during Infection by Different Dengue Virus Serotypes in Primary and Secondary Infections. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154760"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Vicente, C.R., Herbinger, K.H., Fr\u00f6schl, G., Malta Romano, C., de Souza Areias Cabidelle, A., and Cerutti Junior, C. (2016). Serotype influences on dengue severity: A cross-sectional study on 485 confirmed dengue cases in Vit\u00f3ria, Brazil. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1668-y"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"999","DOI":"10.4269\/ajtmh.14-0628","article-title":"Dengue serotype-specific differences in clinical manifestation, laboratory parameters and risk of severe disease in adults, Singapore","volume":"92","author":"Yung","year":"2015","journal-title":"Am. J. Trop. Med. Hyg."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/12\/9\/913\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:03:43Z","timestamp":1760177023000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/12\/9\/913"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,20]]},"references-count":52,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["v12090913"],"URL":"https:\/\/doi.org\/10.3390\/v12090913","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,20]]}}}