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There are two general pathways through which hyperendemicity
may increase the probability of DHF:
- First, as we see on the left, in a situation of hyperendemicity,
where several virus serotypes are circulating at high levels,
the probability of virulent strains occurring is increased,
which increases the probability of DHF.
- In addition, as is presented on the right, in a situation
of hyperendemic transmission, the probability that an individual
will experience a secondary infection is increased, which
increases the likelihood of immune enhancement and DHF.
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