Position paper: The role of vaccination in an Integrated Management Strategy for control of dengue infection

Dengue is a highly prevalent disease in more than 140 countries, which equates to more than half of the world’s population. It affects approximately 390 million people annually, of which, almost 100 million are symptomatic, which means they represent a significant burden for health systems of the affected countries. With the recent availability of a licensed dengue vaccine, vaccination should be considered as an additional tool within an Integrated Management Strategy. Currently, there is only one licensed vaccine available (CYD-TDV, Dengvaxia) although several vaccines are in different phases of development. Data are presented from two Phase III clinical trials with CYD-TDV, one in Asia (children aged 2-14 years) and the other in Latin America (children aged 9-16 years), which demonstrated an acceptable safety and efficacy profile but that efficacy varies according to circulating serotypes, and age and prior immune status of the vaccinated population. Vaccine efficacy was highest in the older children, those with prior immunity and those in whom serotypes 3 and 4 were most prevalent. As a result, the vaccine is now recommended by WHO(SAGE) as one component of an Integrated Management Strategy in regions with a high disease incidence (where seroprevalence exceeds 70%). It has now been adopted into government programs in Brazil and the Philippines and is under consideration for other countries. Evaluation of the cost-effectiveness of dengue vaccination should take into account not only efficacy but the impact on the human and financial cost of disease burden prevented.This paper describes the main conclusions of the fourth meeting of the International Dengue Initiative (IDI) held in April 2016 and endorsed by the Sociedad Latinoamericana de Infectologia Pediatrica (SLIPE), Asociación Latinoamericana de Pediatría (ALAPE) and Asociación Panamericana de Infectología (API). The IDI recommends the introduction of the vaccine into public vaccination programs at a national and sub-national level, to children over the age of 9 in endemic regions.