Dengue fever becomes more virulent during a second infection by means of antibody dependent enhancement.

Antibody dependent enhancement and persistence in macrophages of an arbovirus associated with arthritis.

A further complication to understanding the pathogenesis of this disease and to its control, is the possible role of antibody dependent enhancement of infection (ADE).

The enhanced replication of virus seen in dengue hemorrhagic fever is generally seen upon reinfection by dengue virus of a serotype different from previous infections and is believed to be mediated by antibodies against viral structural proteins: so called antibody dependent enhancement of infection, or ADE.