There is a marked increase in dengue infections worldwide. Sri Lanka has experienced dengue outbreaks for the last 3 decades with evidence of co-circulation of Zika and other flaviviruses. The occurrence of severe disease or asymptomatic infection depends on prior flavivirus immunity, comorbidities, viral factors and vaccination. Our data shows that infection to dengue virus, varies widely among different regions in Sri Lanka. Further, our longitudinal studies in community cohorts and studies in hospital cohorts have shown that individuals with a previous multi-typic exposure also developed symptomatic and asymptomatic dengue infections. Therefore, it would be important to study how each of these factors interact to increase dengue disease severity.
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