CYD‐TDV (Dengvaxia) use in travellers should be considered on a case‐by‐case basis, with a detailed discussion of risks and benefits in light of its safety and efficacy profile
Dengue has a significant impact on global health and is a leading cause of illness in travellers who visit dengue endemic countries. There are four serotypes of dengue virus, belonging to the Flaviviridae family, that are transmitted to humans by Aedes spp. mosquitoes. Infection with dengue virus can be asymptomatic or cause a self‐limited febrile illness, but can also cause severe infection. Secondary infection is a risk factor for severe dengue and one of the proposed mechanisms is antibody‐dependent enhancement of dengue infection. It has been shown that antibody‐dependent enhancement results from the presence of pre‐existing antibodies arising from a primary dengue virus infection that bind to an infecting dengue virus particle in a secondary infection with a different serotype. This results in an antibody–antigen complex that enhances virus entry and replication in monocytes and increases risk of severe illness.1 A key consideration for the development of an effective dengue vaccine has been how best to achieve efficacy against all four serotypes without significant safety concerns.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Katzelnick LC, Gresh L, Halloran ME, et al. Antibody‐dependent enhancement of severe dengue disease in humans. Science 2017; 358: 929–932.
- 2. Australian Technical Advisory Group on Immunisation. ATAGI clinical advice for immunisation providers regarding use of Dengvaxia for Australians. Canberra: Australian Government Department of Health, 2019. https://www.health.gov.au/news/clinical-advice-atagi-statement-on-use-of-dengvaxiar-for-australians (viewed Dec 2019).
- 3. World Health Organization. Revised SAGE recommendation on use of dengue vaccine. 19 Apr 2018. Geneva: WHO, 2019. https://www.who.int/immunization/diseases/dengue/revised_SAGE_recommendations_dengue_vaccines_apr2018/en/ (viewed Dec 2019).
- 4. Capeding MR, Tran NH, Hadinegoro SR, et al. Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer‐masked, placebo‐controlled trial. Lancet 2014; 384: 1358–1365.
- 5. Villar L, Dayan GH, Arredondo‐Garcia JL, et al. Efficacy of a tetravalent dengue vaccine in children in Latin America. N Engl J Med 2015; 372: 113–123.
- 6. Hadinegoro SR, Arredondo‐Garcia JL, Capeding MR, et al. Efficacy and long‐term safety of a dengue vaccine in regions of endemic disease. N Engl J Med 2015; 373: 1195–1206.
- 7. Arredondo‐Garcia JL, Hadinegoro SR, Reynales H, et al. Four‐year safety follow‐up of the tetravalent dengue vaccine efficacy randomized controlled trials in Asia and Latin America. Clin Microbiol Infect 2018; 24: 755–763.
- 8. Simmons CP. A candidate dengue vaccine walks a tightrope. N Engl J Med 2015; 373: 1263–1264.
- 9. Sridhar S, Luedtke A, Langevin E, et al. Effect of dengue serostatus on dengue vaccine safety and efficacy. N Engl J Med 2018; 379: 327–340.
- 10. Rowe SL, Thevarajan I, Richards J, et al. The rise of imported dengue infections in Victoria, Australia, 2010‐2016. Trop Med Infect Dis 2018; 3: 9.
- 11. O'Brien D, Tobin S, Brown GV, Torresi J. Fever in returned travelers: review of hospital admissions for a 3‐year period. Clin Infect Dis 2001; 33: 603–609.
- 12. Ratnam I, Black J, Leder K, et al. Incidence and seroprevalence of dengue virus infections in Australian travellers to Asia. Eur J Clin Microbiol Infect Dis 2012; 31: 1203–1210.
- 13. Ritchie SA. Wolbachia and the near cessation of dengue outbreaks in Northern Australia despite continued dengue importations via travellers. J Travel Med 2018; 25: tay084.
- 14. Masyeni S, Yohan B, Somia IKA, et al. Dengue infection in international travellers visiting Bali, Indonesia. J Travel Med 2018; 25: tay061.
- 15. Sohail A, McGuinness SL, Lightowler R, et al. Spectrum of illness among returned Australian travellers from Bali, Indonesia: a 5‐year retrospective observational study. Intern Med J 2019; 49: 34–40.
- 16. Takeda. Takeda's dengue vaccine candidate meets primary endpoint in pivotal phase 3 efficacy trial. 30 Jan 2019. https://www.takeda.com/newsroom/newsreleases/2019/takedas-dengue-vaccine-candidate-meets-primary-endpoint-in-pivotal-phase-3-efficacy-trial/ (viewed Dec 2019).
- 17. Wilder‐Smith A. Serostatus‐dependent performance of the first licensed dengue vaccine: implications for travellers. J Travel Med 2018; 25: tay057.
Joseph Torresi has received an unrestricted research grant from Sanofi Pasteur, and speaking honoraria from Sanofi and Takeda Pharmaceutical Company, manufacturers of dengue vaccine.