Transmission of dengue 1 and 2 viruses in Greece in 1928

In August-September 1928 appoximately 650,000 residents of Athens and Piraeus contracted dengue fever, and 1,061 died. We were interested in the etiology of this severe epidemic in which many cases resembled dengue hemorrhagic fever or the dengue shock syndrome, and have attempted a retrospective seroepidemiological study. Serum specimens were obtained from 111 residents of Athens or Piraeus who were born in 1927 or 1928, and were studied by plaque reduction neutralization test for antibodies to dengue 1-4 viruses. Of 75 persons born in 1928, 20 (27%) had monospecific dengue 1, 10 (13%) had monospecific dengue 2, and 1 (1%) had dengue 1 and 2 neutralizing antibodies. When prevalence of neutralizing antibody was analyzed by month of birth in 42 individuals, evidence of both dengue 1 and 2 infections was found in persons born in January-July, but only dengue 2 antibody was detected in those who were born after July. This study dates dengue 1 and dengue 2 transmission to 1928, allowing for the possibility that sequential infections with these viruses could have played a pathogenetic role in the outbreak.