(A) The relative circulation of DENV serotypes (DENV-1 in pink; DENV-2 in green; DENV-3 in blue) by year in Nicaragua from 1994 to 2009 as derived from various DENV epidemiological studies across these years (48, 66–69). (B) The proportion of children from the Cohort study who were immune to DENV plotted as a function of birth year. Immunity was measured annually by Inhibition ELISA in samples collected prior to each epidemic season. The dotted lines separate “DENV-3-era” (born before 1999; blue), “DENV-2-era” (born between 1999 and 2002; green) and “DENV-1-era” (born between 2003 and 2006; pink) children as analyzed in our study. Birth year color codes correspond to dominant sertoype as defined in panel A and are shown to the right of the graph. (C) Proportion of patients in the Cohort study in each birth year immune to DENV-1 (pink) or DENV-3 (blue) as determined by assaying neutralizing antibody titers (NT50 determined using RVP assay) to DENV-1 and DENV-3; N is the total number of samples analyzed from each year; the number of samples assayed in each year that did not generate significant titers for either DENV-1 or DENV-3 were 1/5 (1995), 1/8 (1996), 0/10 (1997), 3/5 (1998), 0/1 (1999), 1/3 (2000), 2/8 (2001), 0/2 (2003); nd, not determined.