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Predrag Sikiric, Sven Seiwerth, Zeljko Grabarevic, Petek, M., Rucman, R., Turkovic, B., Ivo Rotkvic, Vjekoslav Jagic, Duvnjak, M., Mise, S., Sanja Djacic, Jadranka Separovic, Marija Veljaca, Ahmet Sallmani, Banic, M., & Brkic, T

Since many antibodies against different dengue serotypes are cross-reactive but non-neutralizing, secondary infections with heterologous strains can result in increased viral replication and more severe disease, leading to major safety risks as reported in a recent dengue vaccine trial 13,14

It reflects a deeper immune imbalance involving the IL-17 and IL-23 inflammatory pathways, gut microbiome dysbiosis, genetic predisposition (HLA-B27 and related alleles), and environmental triggers including trauma, infection, and metabolic dysfunction

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