Human study supports theory on why dengue can be worse the next time around

Et tu, antibody? In humans, dengue can be more severe the second time around. Now, a study implicates an immune system treachery as the culprit.

The study suggests that the amount of anti-dengue antibodies a person has matters. In a 12-year study of Nicaraguan children, low levels of dengue antibodies left over in the blood from a prior infection increased the risk of getting a life-threatening form of the disease the next time around, researchers report online November 2 in Science.

Four related viruses cause dengue. The theory that antibodies protective against one type of dengue can collude with a different type of the virus to make a second infection worse was proposed in the 1960s. Such antibody-dependent enhancement has been shown in cells and lab animals. But “there’s been this controversy for five decades about, does this antibody-dependent enhancement really happen in dengue” in humans, says coauthor Eva Harris, a viral immunologist at the University of California, Berkeley’s School of Public Health. “And this says, yes, it does.”

About 2.5 billion people live where there is a risk of dengue infection. The virus infects 50 million to 100 million people every year, the World Health Organization estimates, but many cases go unreported. Infection with the mosquito-transmitted virus often leads to no symptoms, but can cause fever, joint and muscle pain and other flulike symptoms. The most severe form, which affects about half a million people annually, can include internal bleeding, respiratory distress or organ failure, and may be fatal.
Getting sick with one of the four virus types can protect against a future infection of the same type. But in some cases, the theory goes, leftover antibodies from the first illness can actually help the second infection invade cells, increasing the risk of severe dengue disease.

“This study provides support for this idea that antibodies under certain conditions can be bad and actually cause severe disease when people are infected with dengue,” says viral immunologist Sujan Shresta of the La Jolla Institute for Allergy and Immunology in California. The next step, she says, is to learn more about the antibodies involved and see whether the findings hold up in other populations.

From 2004 to 2016, Harris and her colleagues studied more than 6,500 children aged 2 to 14 in Managua, Nicaragua. The researchers took blood samples each year, at a time when the kids were healthy, and assessed their antibody levels. The scientists also monitored which kids developed dengue and how severe the disease was.

An analysis showed that kids with a specific low range of anti-dengue antibodies had around a 7½ times higher risk of developing the most severe form of the disease than those who had either no antibodies or a high amount. The team’s test couldn’t tell what kind of dengue antibodies each child had. Harris and colleagues are now working on characterizing the antibodies measured in their test, to learn what makes them protective or harmful.

The new study supports the theory of antibody-dependent enhancement in humans, says Anna Durbin, an infectious diseases physician at Johns Hopkins Bloomberg School of Public Health. But she also argues that the risk of developing severe disease depends on the quality of the antibody — that is, how potent it is — as much as, or more than, the quantity. “A number in and of itself doesn’t tell you a whole lot.”

Terence Crawford vs. Shawn Porter results: Crawford retains WBO welterweight title with 10th-round stoppage

LAS VEGAS — All the questions about Terence Crawford have been answered.

For years, the only knock on him was that he lacked a signature victory. He finally picked up one — and in exceptional fashion — when he became the first fighter to stop Shawn Porter, recording a 10th-round TKO to retain his WBO welterweight championship in front of 11,568 fans at Michelob ULTRA Arena.
Now, the world will be clamoring for a unification bout with IBF and WBC champion Errol Spence Jr.

As it always has been against Porter, winning didn't come easy.

At the time of the stoppage, Crawford was up on all three scorecards: 86-85, 86-85 and 87-84. Porter routinely barreled inside and kept Crawford off balance with aggression and pressure. But Crawford began to time Porter's advances and then picked him off with counters that eventually wore down the former two-time champion.

In the 10th round, Crawford opened with a thudding left hand that deposited Porter on his backside. A frustrated Porter made it to his feet but was met with a scintillating combination that dropped Porter to his knees. Porter pounded on the canvas out of frustration and made it back to his feet again. Unfortunately, his father and trainer, Kenny Porter, decided that his son had had enough and threw in the towel.

Crawford improved to 38-0 with 29 knockouts. Porter became his ninth consecutive knockout victim. As for Porter, his career is at a crossroads of sorts as he falls to 31-4-1 and goes to the back of the line when it comes to title opportunities.

Here's how it all went down in Las Vegas.

Terence Crawford vs. Shawn Porter live updates, highlights
(All times Eastern.)

Round 10 (12:15 a.m.): Crawford drops Porter with a left hand to open the round! Porter is up and Crawford is a killer. He’s looking to finish the job. Crawford with a barrage that drops Crawford. Porter beats the canvas on his way up. Porter’s corner stops it! Wow!

Round 9 (12:13 a.m.): Short left hand by Porter lands to open the round. Big hook by Porter barely lands. Bud is unbothered. Body shot by Porter. Crawford looking for his spots and Porter isn’t making it easy. Crawford lands an uppercut on the inside and a body shot. 10-9, Crawford (86-85, Crawford)

Round 8 (12:09 a.m.): Crawford with a hard right hand and Porter comes straight at him throwing bombs. Crawford avoids and picks him off with a right hand. Beautiful sequence by Bud. Porter chops him on the inside with a short left and barrels inside. Hard left hand by Porter. Big right hand by Porter rattles Crawford. Crawford smiles and centers himself. How do you score this round? 10-9, Crawford (76-76)

Round 7 (12:04 a.m.): Porter strafes Bud with a left hand. Crawford gives Porter different looks and feints. They exchange left hands. Right hand by Porter lands and Crawford bounces off the ropes. Short counter right by Crawford as Porter rolls in. Porter won’t stop coming. Bud is smiling again. But he’s not throwing enough. 10-9, Porter (67-66, Porter)

Round 6 (12:01 a.m.): Crawford lands a big right hand They are going to war again. Crawford looking for the big shot and loading up. Porter comes roaring back. They clash heads. Crawford looks like he’s enjoying the dog fight. Porter roughs him up on the inside. Man, this is a damn fight. Counter left on the inside by Crawford. Lots of infighting to close a tight round. 10-9, Crawford (57-57)

Round 5 (11:57 p.m.): Porter working on Bud from the inside with some roughhousing. Crawford trying to walk Porter down. Flashes the jab. Porter bombing away on Crawford as he covers up. Not a lot gets through. Crawford walking him down. Porter is just outworking him in this round but Crawford is hoping he spent up his gas tank. 10-9, Porter (48-47, Porter)

Round 4 (11:52 p.m.): Hard left hook from Porter to open the round. Crawford lands a combination and a left hand. They exchange hard shots. Porter lands a right hand and Bud smiles. Porter with a jab and Bud responds to the body. Porter with a lunging hook that lands. Crawford with a check hook that almost Ricky Hatton'd Porter. They start swinging again. Closer round. 10-9, Crawford (38-38)

Round 3 (11:48 p.m): Crawford looks comfortable fighting lefty. Starts pushing Porter back. Porter lands a hard combination. Crawford tried to time and barely missed a counter hook. Porter stuns Bud with a left hand! Bud smiles but he was cracked. They are talking now. Porter is cut over the right eye. Crawford smiling but he knows that he's now in a fight. 10-9, Porter (29-28, Porter)

Round 2 (11:44 p.m.): Porter lands a jab and Bud switches to southpaw. Barely misses a counter. Lands a hard right hand on Porter. Porter cracks Bud with a hard right hand in response. Crawford lands a right hand and barely misses an uppercut. A firefight breaks out. Both landing hard shots. Bud with a counter uppercut and Porter with a right hand. Crawford lands the jab and smiles. We're about to have a good one. 10-9, Crawford (19-19)

Round 1 (11:40 p.m.): Porter rushes right at Crawford with a left hook and follows with a right hand that lands. Porter aims to rough Bud up along the ropes and gets tied up. Crawford is reading and timing Porter. Starts to fire the jab. Left hand by Porter lands. Hard jab by Bud lands. Crawford smirks at Porter. He may have figured out something already. 10-9, Porter

11:30 p.m.: "Showtime" Shawn Porter makes his entrance with WWE champion Big E and Grammy-nominated Hip Hop artist Rapsody while Terence Crawford keeps it simple by walking alone to LL Cool J's "I'm Bad."

10:58 p.m.: Through six rounds, Esquiva Falcao, the 2012 Olympic silver medalist from Brazil, has been applying immense pressure to Patrice Volny. Volny tried to work from the outside but Falcao's persistence to throttle Volny from the inside racked up rounds. But a nasty clash of heads in the sixth round split Falcao open above the left eye. Falcao is in a lot of pain and it's likely this fight is going to be stopped. Yup, it's over. Main event is next.

10:22 p.m.: Janibek Alimkhanuly didn't have much trouble turning back the challenge of Hassan N'Dam. He chopped him down over the course of eight rounds to earn the TKO stoppage. N'Dam's best years as a contender are clearly behind him, while Alimkhanuly remains one to watch in the middleweight division. As the rounds wore on, it became target practice for Alimkhanuly. N'Dam offered little resistance and was routinely clocked by power punches and a hard left hand. The mounting damage was too much for referee Kenny Bayless and the fight was called at the 2:40 mark of the eighth.

9:37 p.m.: As expected, Muratalia mowed down Araujo with an exceptional display of body punching and aggression to pick up the fifth-round TKO.

9 p.m.: We're live from Las Vegas and the pay-per-view portion of Crawford-Porter will kick off with Raymond Muratalla and Elias Araujo competing in a lightweight showdown.

Terence Crawford vs. Shawn Porter start time
Date: Saturday, Nov. 20
Main card time: 9 p.m. ET | 6 p.m. PT
Main event: 11 p.m. ET | 8 p.m. PT (approx.)
Crawford and Porter are set to step into the ring at about 11 p.m. ET. The night will begin with early prelims at 6 p.m. ET, followed by the prelim card at 7 p.m. ET and the main card at 9 p.m. ET.
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CONCACAF 2022 World Cup Qualifying: Schedule, standings, TV for soccer Octagonal

We're now into the second half of the qualifying schedule and it's Canada at the top of the CONCACAF 2022 World Cup qualifying standings.

A 2-1 home win over Mexico allowed the Canadians to overtake the USA atop the eight-team table. Canada is the only remaining unbeaten team in qualifying as it continues to push to qualify for its first World Cup since 1986.

The USA (2nd, 15 points) and Mexico (3rd, 14 points), long the powers of the region, are now chasing. Meanwhile, Panama continued its surge with another dramatic come-from-behind victory to go level with Mexico on 14 points. The top three teams earn automatic berths to the World Cup, while fourth-place earns passage to a play-in series for one of the final spots in Qatar 2022.

The other half of the table is in precarious position. A group of three teams — Costa Rica (5th), Jamaica (6th), El Salvador (7th) — is now between 5-8 points behind Panama for fourth place. Meanwhile, it's looking unlikely that Honduras will be able to recover from its last-place point total. 

The first standings tiebreakers are (1) goal difference, (2) goals scored and (3) most points obtained from matches between teams that are tied. The full list of tiebreakers and results for Matchdays 1-7 follow at the bottom of this post.

CONCACAF World Cup Qualifying Standings & Results
Team PTS GP W L D GF GA GD

  1. Canada 16 8 4 0 4 13 5 +8
  2. USA 15 8 4 1 3 12 5 +7
  3. Mexico 14 8 4 2 2 11 7 +4
  4. Panama 14 8 4 2 2 11 9 +2
  5. Costa Rica 9 8 2 3 3 6 7 -1
  6. Jamaica 7 8 1 3 4 6 10 -4
  7. El Salvador 6 8 1 4 3 4 10 -6
  8. Honduras 3 8 0 5 3 5 15 -10
    Matchday 8
    Date Match
    Tues, Nov. 16, 2021 Jamaica 1 , USA 1 Highlights
    Tues, Nov. 16, 2021 Costa Rica 2 , Honduras 1 Highlights
    Tues, Nov. 16, 2021 Panama 2 , El Salvador 1 Highlights
    Tues, Nov. 16, 2021 Canada 2, Mexico 1 Highlights
    Matchday 9
    Date Match Time (ET) Stream
    Thurs, Jan. 27, 2022 Honduras vs. Canada TBD TBD
    Thurs, Jan. 27, 2022 USA vs. El Salvador TBD TBD
    Thurs, Jan. 27, 2022 Costa Rica vs. Panama TBD TBD
    Thurs, Jan. 27, 2022 Jamaica vs. Mexico TBD TBD
    Matchday 10
    Date Match Time (ET) Stream
    Sun, Jan. 30, 2022 Canada vs. USA TBD TBD
    Sun, Jan. 30, 2022 Honduras vs. El Salvador TBD TBD
    Sun, Jan. 30, 2022 Mexico vs. Costa Rica TBD TBD
    Sun, Jan. 30, 2022 Panama vs. Jamaica TBD TBD
    Matchday 11
    Date Match Time (ET) Stream
    Wed, Feb. 2, 2022 El Salvador vs. Canada TBD TBD
    Wed, Feb. 2, 2022 USA vs. Honduras TBD TBD
    Wed, Feb. 2, 2022 Mexico vs. Panama TBD TBD
    Wed, Feb. 2, 2022 Jamaica vs. Costa Rica TBD TBD
    Matchday 12
    Date Match Time (ET) Stream
    Thurs, March 24, 2022 Costa Rica vs. Canada TBD TBD
    Thurs, March 24, 2022 Panama vs. Honduras TBD TBD
    Thurs, March 24, 2022 Jamaica vs. El Salvador TBD TBD
    Thurs, March 24, 2022 Mexico vs. USA TBD TBD
    Matchday 13
    Date Match Time (ET) Stream
    Sun, March 27, 2022 Canada vs. Jamaica TBD TBD
    Sun, March 27, 2022 Honduras vs. Mexico TBD TBD
    Sun, March 27, 2022 El Salvador vs. Costa Rica TBD TBD
    Sun, March 27, 2022 USA vs. Panama TBD TBD
    Matchday 14
    Date Match Time (ET) Stream
    Wed, March 30, 2022 Panama vs. Canada TBD TBD
    Wed, March 30, 2022 Jamaica vs. Honduras TBD TBD
    Wed, March 30, 2022 Mexico vs. El Salvador TBD TBD
    Wed, March 30, 2022 Costa Rica vs. USA TBD TBD
    CONCACAF World Cup Qualifying results & highlights
    Matchday 1
    Date Match
    Thurs, Sept. 2, 2021 Canada 1, Honduras 1 Highlights
    Thurs, Sept. 2, 2021 Panama 0, Costa Rica 0 Highlights
    Thurs, Sept. 2, 2021 Mexico 2, Jamaica 1 Highlights
    Thurs, Sept. 2, 2021 El Salvador 0, USA 0 Highlights
    Matchday 2
    Date Match
    Sun, Sept. 5, 2021 Jamaica 0, Panama 3 Highlights
    Sun, Sept. 5, 2021 Costa Rica 0, Mexico 1 Highlights
    Sun, Sept. 5, 2021 El Salvador 0, Honduras 0 Highlights
    Sun, Sept. 5, 2021 USA 1, Canada 1 Highlights
    Matchday 3
    Date Match
    Wed, Sept. 8, 2021 Canada 3, El Salvador 0 Highlights
    Wed, Sept. 8, 2021 Panama 1, Mexico 1 Highlights
    Wed, Sept. 8, 2021 Costa Rica 1, Jamaica 1 Highlights
    Wed, Sept. 8, 2021 Honduras 1, USA 4 Highlights
    Matchday 4
    Date Match
    Thurs, Oct. 7, 2021 USA 2, Jamaica 0 Highlights
    Thurs, Oct. 7, 2021 Honduras 0, Costa Rica 0 Highlights
    Thurs, Oct. 7, 2021 Mexico 1, Canada 1 Highlights
    Thurs, Oct. 7, 2021 El Salvador 1, Panama 0 Highlights
    Matchday 5
    Date Match
    Sun, Oct. 10, 2021 Panama 1, USA 0 Highlights
    Sun, Oct. 10, 2021 Jamaica 0, Canada 0 Highlights
    Sun, Oct. 10, 2021 Costa Rica 2, El Salvador 1 Highlights
    Sun, Oct. 10, 2021 Mexico 3, Honduras 0 Highlights
    Matchday 6
    Date Match
    Wed, Oct. 13, 2021 USA 2, Costa Rica 1 Highlights
    Wed, Oct. 13, 2021 Canada 4, Panama 1 Highlights
    Wed, Oct. 13, 2021 Honduras 0, Jamaica 2 Highlights
    Wed, Oct. 13, 2021 El Salvador 0, Mexico 2 Highlights
    Matchday 7
    Date Match
    Fri, Nov. 12, 2021 Honduras 2 , Panama 3 Highlights
    Fri, Nov. 12, 2021 USA 2 , Mexico 0 Highlights
    Fri, Nov. 12, 2021 Canada 1 , Costa Rica 0 Highlights
    Fri, Nov. 12, 2021 El Salvador 1 , Jamaica 1 Highlights
    How CONCACAF World Cup Qualifying works
    Eight nations from the CONCACAF region (North America, Central America and the Caribbean) are competing for three automatic berths to the 2022 Qatar World Cup in the final "octagonal" qualifying round.

The eight countries are facing off in a round-robin format with each team playing the other seven opponents once at home and once on the road. The 14 total matches for each national team began in September 2021 and will wrap up in March 2022.

The top three finishers will earn automatic berths to Qatar, while the fourth-place team will head to an intercontinental playoff with a final ticket to Qatar on the line. Here are the standings tiebreakers for teams even on points:

Goal difference in all group matches
Most goals scored in all group matches
Most points obtained from group matches between teams concerned
Goal difference from group matches between teams concerned
Most goals scored in group matches between teams concerned
Goals scored away from home (if two teams tied)
Discipline points (based on yellow/red cards)
Drawing of lots by FIFA
The Qatar World Cup will be played from Nov. 21 to Dec. 18, 2022.

Why isn't Trey Lance starting? 49ers' commitment to Jimmy Garoppolo makes messy QB situation

49ers fans waiting for the return of the "Trey Area" may have to wait a little longer.

The 49ers sending away two future first-round picks for the No. 3 overall pick for, what turned out to be, Trey Lance in the 2021 NFL Draft meant that the future was now. Or later. Or, apparently, eventually.
Kyle Shanahan and the 49ers have maintained that the best way to develop their prized QB prospect is to keep him on the bench, a strategy that may or may not work out long-term for them.

With Jimmy Garoppolo still a serviceable starter for San Francisco, the 3-5 start has fans calling for a change at the quarterback spot, leading to many wondering why Lance isn't starting. While draft philosophies differ, one thing is certain: The 49ers spent a lot of future draft capital for a guy who's gotten a very small sample size of work so far this season.

Shanahan's comments haven't painted a pretty picture for Lance's starting prospects in 2021, either.

Why isn't Trey Lance starting?
The answer: Anyone's guess.

While Lance got an opportunity to fill in for Jimmy Garoppolo in Week 5 vs. the Cardinals, he's been on the sidelines since then. Through a bye week, a knee injury and Garoppolo getting the opportunity to start once again, the 49ers have resisted the urge to let Lance see the field. Lance last got a snap in Week 5.

While Lance came out of college as something of a project, it seems like the 49ers' direction is to do more to try and develop Lance for the future than to shoehorn him into situations now after attempting to earlier in the season.

In late October, head coach Kyle Shanahan explained why Lance hasn't been given a longer leash to start:

“We didn’t draft Trey to just fix this year," Shanahan said. "We drafted him so he could be the quarterback of the future and that’s a matter of time. We are not playing him just because what our record is, or just because."

There's also the matter of Jimmy Garoppolo, who has played "all right" (Shanahan's words) despite missing a game with an injury. ESPN's Dan Graziano reported that he doesn't feel that Shanahan will make the change to Garoppolo anytime soon — not as long as Garoppolo is playing, well, all right.

On Halloween, Lance was seemingly healthy and ready to go. Shanahan, though, didn't want to risk putting Lance on the field in the event that Garoppolo was injured.

To that end, the question remains: Not that Lance's usage rate was out of this world, but why were the 49ers more willing to use Lance early on in the season (129 snaps in total through Week 5) and not now?

The resistance to want to use Lance continued in this past weekend: Following the rough Week 9 loss to an undermanned Cardinals team, Shanahan was asked if he'd consider making a QB change for the Niners' Week 10 game vs. the Rams.

"Probably not, but definitely not thinking about those things right now. I’m thinking about this game and the rest of our team," Shanahan said post-game.

Defenses have been playing the 49ers passing game tighter, with Garoppolo's propensity to work short throws and the middle of the field (as the Shanahan system accounts for). Garoppolo's ability to stretch the field has always been something of a question, something that Lance's physical traits would allow him to do.

But, come hell or high water, it sounds like it's going to be Garoppolo — for now.