Dengue, Now a Vaccine Preventable Disease
Dengue is an acute febrile illness caused by one of the four dengue serotypes (DENV-1, DENV-2, DENV-3 and DENV-4), and transmitted by Aedes mosquitoes. Infection with dengue virus can cause a spectrum of illness ranging from asymptomatic infections or self-limiting influenza-like illness to life-threatening manifestations with severe hemorrhage and vascular leakage, that can potentially lead to vascular shock and even death.There is no specific treatment for dengue; the standard of care is supportive treatment. Current strategies for disease control rely on early diagnosis, appropriate case management, and vector control programs.
During the past five decades, dengue incidence has increased 30-fold, making it one of the fastest-spreading vector-borne diseases. The disease is now endemic in 128 countries, and it is estimated that,worldwide, 3.9 billion people are currently at risk of infection. Nowadays, severe forms of dengue affect most Asian and Latin American countries where it has become a leading cause of hospitalization and death, particularly among the pre-adolescent and young adult populations.
As of December 2015, dengue is a vaccine preventable disease. The CYD-TDV vaccine (commercial name Dengvaxia®) is a Sanofi Pasteur dengue tetravalent vaccine (live attenuated), that has been licensed for the prevention of dengue in more than 10 countries in Latin America and Asia Pacific.It is indicated for use in individuals aged 9-45 or 9-60 years (depending on country license) living in endemic areas, using a three-dose series on a 0/6/12-month schedule.CYD-TDV has been shown to protect against virologically confirmed dengue and severe dengue, and no significant safety signals have been observed in persons aged nine years and over. Its introduction should complement existing dengue surveillance, mosquito vector control, and dengue case management. Dengue risk is highly variable between and within countries, and thus priority for using the vaccine will vary accordingly.
Development of a Toolkit for Implementing the Dengue Vaccine
AMP Services has been developing a toolkit for dengue vaccination program, composed of a series of modules and interactive documents. The purpose is to summarize key accessible information to help decision makers and program planners (including Ministry of Health staff and NITAG members) make country decisions on dengue vaccine introduction.
The dengue vaccination program toolkit includes:
- Ten modules:
- Module 1: Information on the Dengue Vaccine.
Summarizes key accessible information on dengue disease and burden, and on the new dengue vaccine CYD-TDV- current version on the right panel
- Module 2: Implementation Strategies.
Summarizes issues associated with the implementation of the dengue vaccine, including determining priority areas for initial vaccine use, methods for determining disease burden, and implementation strategies –current version on the right panel
- Module 3: Immunization Sessions.
Focuses on key questions regarding the organization and management of immunization sessions with CYD-TDV, with the main focus on a school-based strategy– current version on the right panel
- Module 4: Impact Evaluation.
Helps identify key parameters regarding the impact assessment of CYD-TDV– current version on the right panel
- Module 5: Pharmacovigilance.
Summarizes safety and pharmacovigilance information and issues relevant to the implementation of CYD-TDV–current version on the right panel
- Module 6: Dengue Vaccine Communication (under development)
- Module 7: Dengue Vaccine Rumors Management (under development)
- Module 8: Dengue Vaccine Social Mobilization (under development)
- Module 9: Dengue Outbreak and Evaluation
Summarizes key accessible information on dengue outbreak detection and response, and discuss the use of the new dengue vaccine CYD-TDV in the context of dengue outbreaks - current version on the right panel
- Module 10 : Diagnosis Strategies
Summarizes key accessible information on dengue diagnosis, and discusses dengue diagnosis strategies in the context of circulation of other flaviviruses, and of vaccination with the dengue vaccine CYD-TDV - current version on the right panel
- Module 1: Information on the Dengue Vaccine.
- Interactive Companion Tool for implementation.The Excel tool (current version on the right panel) helps to summarize and evaluate country information on:
- Disease burden by area, by age, and by year
- Public health impact outcomes such as vaccine preventable disease incidence (VPDI), number needed to vaccinate (NNV), and number of cases averted
- Target population data, including age cohorts, school and out-of-school populations.
- Impact of vaccine implementation strategies (routine +/- introductory catch up cohorts)
- Basic needs for vaccine implementation (number of doses, basic logistic requirements)
- A Case-Studies Library: compiling a number of country experiences on the various topics covered by the modules (under development)
The Dengue Vaccination Program Toolkit is available in English, Spanish, and Portuguese, to facilitate its use in Asia Pacific and Latin America regions.
The development of the toolkit started in February 2016 and follows an incremental and interactive process, with the inclusion of feedback from country consultations, international meetings and experts, World Health Organization (WHO) recommendations, international organizations’ reports, and scientific literature. The material will be regularly updated.
As of November 2016, a systematic collection of comments, suggestions, and experiences is being organized on this page. Please download the modules and send your comments and experiences to the following email address: email@example.com.
Your message will be acknowledged and will help to improve the dengue vaccination program toolkit.