1
|
Hussain Z, Rani S, Ma F, Li W, Shen W, Gao T, Wang J, Pei R. Dengue determinants: Necessities and challenges for universal dengue vaccine development. Rev Med Virol 2023; 33:e2425. [PMID: 36683235 DOI: 10.1002/rmv.2425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
Dengue illness can range from mild illness to life-threatening haemorrhage. It is an Aedes-borne infectious disease caused by the dengue virus, which has four serotypes. Each serotype acts as an independent infectious agent. The antibodies against one serotype confer homotypic immunity but temporary protection against heterotypic infection. Dengue has become a growing health concern for up to one third of the world's population. Currently, there is no potent anti-dengue medicine, and treatment for severe dengue relies on intravenous fluid management and pain medications. The burden of dengue dramatically increases despite advances in vector control measures. These factors underscore the need for a vaccine. Various dengue vaccine strategies have been demonstrated, that is, live attenuated vaccine, inactivated vaccine, DNA vaccine, subunit vaccine, and viral-vector vaccines, some of which are at the stage of clinical testing. Unfortunately, the forefront candidate vaccine is less than satisfactory, and its performance depends on serostatus and age factors. The lessons from clinical studies depicted ambiguity concerning the efficacy of dengue vaccine. Our study highlighted that viral structural heterogeneity, epitope accessibility, autoimmune complications, genetic variants, genetic diversities, antigen competition, virulence variation, host-pathogen specific interaction, antibody-dependent enhancement, cross-reactive immunity among Flaviviruses, and host-susceptibility determinants not only influence infection outcomes but also hampered successful vaccine development. This review integrates dengue determinants allocated necessities and challenges, which would provide insight for universal dengue vaccine development.
Collapse
Affiliation(s)
- Zahid Hussain
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei, China.,CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China.,Molecular Virology Laboratory, Department of Biosciences, Comsats University Islamabad (CUI), Islamabad, Pakistan
| | - Saima Rani
- Molecular Virology Laboratory, Department of Biosciences, Comsats University Islamabad (CUI), Islamabad, Pakistan
| | - Fanshu Ma
- CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| | - Wenjing Li
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei, China.,CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| | - Wenqi Shen
- CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| | - Tian Gao
- CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| | - Jine Wang
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei, China.,CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| | - Renjun Pei
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei, China.,CAS Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou, China
| |
Collapse
|
2
|
Zeyaullah M, Muzammil K, AlShahrani AM, Khan N, Ahmad I, Alam MS, Ahmad R, Khan WH. Preparedness for the Dengue Epidemic: Vaccine as a Viable Approach. Vaccines (Basel) 2022; 10:1940. [PMID: 36423035 PMCID: PMC9697487 DOI: 10.3390/vaccines10111940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 08/08/2023] Open
Abstract
Dengue fever is one of the significant fatal mosquito-borne viral diseases and is considered to be a worldwide problem. Aedes mosquito is responsible for transmitting various serotypes of dengue viruses to humans. Dengue incidence has developed prominently throughout the world in the last ten years. The exact number of dengue cases is underestimated, whereas plenty of cases are misdiagnosed as alternative febrile sicknesses. There is an estimation that about 390 million dengue cases occur annually. Dengue fever encompasses a wide range of clinical presentations, usually with undefinable clinical progression and outcome. The diagnosis of dengue depends on serology tests, molecular diagnostic methods, and antigen detection tests. The therapeutic approach relies completely on supplemental drugs, which is far from the real approach. Vaccines for dengue disease are in various stages of development. The commercial formulation Dengvaxia (CYD-TDV) is accessible and developed by Sanofi Pasteur. The vaccine candidate Dengvaxia was inefficient in liberating a stabilized immune reaction toward different serotypes (1-4) of dengue fever. Numerous promising vaccine candidates are now being developed in preclinical and clinical stages even though different serotypes of DENV exist that worsen the situation for a vaccine to be equally effective for all serotypes. Thus, the development of an efficient dengue fever vaccine candidate requires time. Effective dengue fever management can be a multidisciplinary challenge, involving international cooperation from diverse perspectives and expertise to resolve this global concern.
Collapse
Affiliation(s)
- Md. Zeyaullah
- Department of Basic Medical Science, College of Applied Medical Sciences, Khamis Mushayt Campus, King Khalid University (KKU), Abha 62561, Saudi Arabia
| | - Khursheed Muzammil
- Department of Public Health, College of Applied Medical Sciences, Khamis Mushayt Campus, King Khalid University (KKU), Abha 62561, Saudi Arabia
| | - Abdullah M. AlShahrani
- Department of Basic Medical Science, College of Applied Medical Sciences, Khamis Mushayt Campus, King Khalid University (KKU), Abha 62561, Saudi Arabia
| | - Nida Khan
- Department of Chemical Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Irfan Ahmad
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University (KKU), Abha 62561, Saudi Arabia
| | - Md. Shane Alam
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Razi Ahmad
- Department of Chemistry, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Wajihul H. Khan
- Department of Microbiology, All India Institute of Medical Sciences Delhi, New Delhi 110029, India
| |
Collapse
|
3
|
Abstract
BACKGROUND Dengue is a possibly life-threatening human mosquito-borne viral infection widely spread in peridomestic (sub)tropical climates. The global incidence has expanded rapidly in the last decades, with 40% of the world's population currently at risk. To date, no anti-viral treatment other than supportive care exists. In 2015, the first and only dengue-vaccine, CYD-TDV, received marketing authorization. OBJECTIVES To present the current understanding of dengue in terms of epidemiology, transmission, pathogenesis, disease management and prevention. To illustrate the knowledge gaps that remain to be filled in order to control dengue and achieve the WHO 2010-2020 goals. METHODS An updated systematic review (2009-2019) was carried out. The databases Pubmed, Embase and The Cochrane Library were searched along with WHO and CDC guidelines. RESULTS In total, 39 articles were included. Contemporary climatic and economic factors significantly contributed to the emergence of epidemic dengue. Unfortunately, CYD-TDV failed to meet safety and efficacy demands. New vaccination approaches are in the pipeline along with innovative vector-control strategies. Current anti-viral drug research focuses on repurposing drugs in addition to specific anti-dengue strategies that interfere with viral replication. CONCLUSION The lack of understanding dengue pathogenesis and immunology has hampered the development of an effective vaccine. Recent research has provided new insights into the therapeutic and prophylactic approach. Implementation of complementary methods to control disease burden are required considering the socio-economic impact of this rapidly emerging global disease.
Collapse
Affiliation(s)
- K Wellekens
- Department of general internal medicine, University Hospitals Leuven, Leuven, Belgium
| | - A Betrains
- Department of general internal medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of clinical infectious and inflammatory disease, Leuven, Belgium
| | - P De Munter
- Department of general internal medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of clinical infectious and inflammatory disease, Leuven, Belgium
| | - W Peetermans
- Department of general internal medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of clinical infectious and inflammatory disease, Leuven, Belgium
| |
Collapse
|
4
|
Andreata-Santos R, Alves RPDS, Pereira SA, Pereira LR, de Freitas CL, Pereira SS, Venceslau-Carvalho AA, Castro-Amarante MF, Favaro MTP, Mathias-Santos C, Amorim JH, Ferreira LCDS. Transcutaneous Administration of Dengue Vaccines. Viruses 2020; 12:v12050514. [PMID: 32384822 PMCID: PMC7290698 DOI: 10.3390/v12050514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 12/28/2022] Open
Abstract
In the present study, we evaluated the immunological responses induced by dengue vaccines under experimental conditions after delivery via a transcutaneous (TC) route. Vaccines against type 2 Dengue virus particles (DENV2 New Guinea C (NGC) strain) combined with enterotoxigenic Escherichia coli (ETEC) heat-labile toxin (LT) were administered to BALB/c mice in a three-dose immunization regimen via the TC route. As a control for the parenteral administration route, other mouse groups were immunized with the same vaccine formulation via the intradermic (ID) route. Our results showed that mice vaccinated either via the TC or ID routes developed similar protective immunity, as measured after lethal challenges with the DENV2 NGC strain. Notably, the vaccine delivered through the TC route induced lower serum antibody (IgG) responses with regard to ID-immunized mice, particularly after the third dose. The protective immunity elicited in TC-immunized mice was attributed to different antigen-specific antibody properties, such as epitope specificity and IgG subclass responses, and cellular immune responses, as determined by cytokine secretion profiles. Altogether, the results of the present study demonstrate the immunogenicity and protective properties of a dengue vaccine delivered through the TC route and offer perspectives for future clinical applications.
Collapse
Affiliation(s)
- Robert Andreata-Santos
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Rúbens Prince dos Santos Alves
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Sara Araujo Pereira
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Lennon Ramos Pereira
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Carla Longo de Freitas
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Samuel Santos Pereira
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Alexia Adrianne Venceslau-Carvalho
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Maria Fernanda Castro-Amarante
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Marianna Teixeira Pinho Favaro
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Camila Mathias-Santos
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Jaime Henrique Amorim
- Center for Biological and Health Sciences, Federal University of Western Bahia, Bahia 47810-047, Brazil;
| | - Luís Carlos de Souza Ferreira
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
- Correspondence: ; Tel.: +55-11-3091-7356
| |
Collapse
|
5
|
Srikiatkhachorn A. What translatable knowledge from dengue vaccine design can we pass onto future anti-parasitic vaccine development? Expert Opin Drug Discov 2020; 15:391-395. [PMID: 32043379 DOI: 10.1080/17460441.2020.1718099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Anon Srikiatkhachorn
- Institute for Immunology and Informatics, College of Environment and Life Sciences, University of Rhode Island, Providence, RI, USA.,Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| |
Collapse
|
6
|
Hladish TJ, Pearson CAB, Toh KB, Rojas DP, Manrique-Saide P, Vazquez-Prokopec GM, Halloran ME, Longini IM. Designing effective control of dengue with combined interventions. Proc Natl Acad Sci U S A 2020; 117:3319-3325. [PMID: 31974303 PMCID: PMC7022216 DOI: 10.1073/pnas.1903496117] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Viruses transmitted by Aedes mosquitoes, such as dengue, Zika, and chikungunya, have expanding ranges and seem unabated by current vector control programs. Effective control of these pathogens likely requires integrated approaches. We evaluated dengue management options in an endemic setting that combine novel vector control and vaccination using an agent-based model for Yucatán, Mexico, fit to 37 y of data. Our intervention models are informed by targeted indoor residual spraying (TIRS) experiments; trial outcomes and World Health Organization (WHO) testing guidance for the only licensed dengue vaccine, CYD-TDV; and preliminary results for in-development vaccines. We evaluated several implementation options, including varying coverage levels; staggered introductions; and a one-time, large-scale vaccination campaign. We found that CYD-TDV and TIRS interfere: while the combination outperforms either alone, performance is lower than estimated from their separate benefits. The conventional model hypothesized for in-development vaccines, however, performs synergistically with TIRS, amplifying effectiveness well beyond their independent impacts. If the preliminary performance by either of the in-development vaccines is upheld, a one-time, large-scale campaign followed by routine vaccination alongside aggressive new vector control could enable short-term elimination, with nearly all cases avoided for a decade despite continuous dengue reintroductions. If elimination is impracticable due to resource limitations, less ambitious implementations of this combination still produce amplified, longer-lasting effectiveness over single-approach interventions.
Collapse
Affiliation(s)
- Thomas J Hladish
- Department of Biology, University of Florida, Gainesville, FL 32611;
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611
| | - Carl A B Pearson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa 7600
| | - Kok Ben Toh
- School of Natural Resources and Environment, University of Florida, Gainesville, FL 32611
| | - Diana Patricia Rojas
- Department of Biostatistics, University of Florida, Gainesville, FL 32611
- Division of Public Health and Tropical Medicine, James Cook University, Townsville QLD 4814, Australia
| | - Pablo Manrique-Saide
- Collaborative Unit for Entomological Bioassays, Universidad Autónoma de Yucatán, Mérida, Mexico 9700
| | | | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109
- Center for Inference and Dynamics of Infectious Diseases, Seattle, WA 98109
- Department of Biostatistics, University of Washington, Seattle, WA 98195
| | - Ira M Longini
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611
- Department of Biostatistics, University of Florida, Gainesville, FL 32611
- Center for Inference and Dynamics of Infectious Diseases, Seattle, WA 98109
| |
Collapse
|
7
|
McMahon E, Encinales L, Navarro Encinales C, Vielma S, Pacheco N, Avendaño Echavez LG, Acosta Rodríguez S, Calderon M, Encinales Sanabria S, Encinales Sanabria L, Serrano Bernal E, Gonzaléz Coba A, Jiménez D, Simon G, Chang AY. A Dengue Vaccine: Will It be Accepted and Is It Feasible? Lessons from Barranquilla, Colombia, and Merida, Venezuela. Microorganisms 2019; 7:E458. [PMID: 31623165 DOI: 10.3390/microorganisms7100458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/17/2022] Open
Abstract
With one vaccine on the market and others in clinical trials, policy makers in dengue endemic regions face the decision of whether to introduce a dengue vaccine in their communities. The World Health Organization (WHO) recommends that individualized assessments be conducted before any vaccine introduction to evaluate disease burden and the strength of current vaccination programs. This study seeks to aid in that decision-making process by examining the acceptability and feasibility of dengue vaccine introduction in Barranquilla, Colombia, and Merida, Venezuela. Surveys were administered February-June of 2018 for three groups: patients (n = 351), health professionals (n = 197), and government officials (n = 26). In Barranquilla, most respondents reported dengue to be a moderate-severe problem, that a dengue vaccine would be useful in their communities, and that their current vaccination programs could handle the addition of a new vaccine. In Venezuela, respondents were less likely to view dengue as a major concern and listed multiple barriers to not just dengue vaccine introduction, but to providing current vaccines as well. Further work is needed in Colombia to more objectively assess the country's readiness as a whole for a future dengue vaccine. As political and social unrest continues in Venezuela, however, future initiatives should focus on trust and capacity building. This study can serve as a framework for future assessments of the acceptability and feasibility of a dengue vaccine in both targeted areas and on larger scales.
Collapse
|
8
|
Halstead S, Wilder-Smith A. Severe dengue in travellers: pathogenesis, risk and clinical management. J Travel Med 2019; 26:5551100. [PMID: 31423536 DOI: 10.1093/jtm/taz062] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE FOR REVIEW Dengue is a frequent cause of febrile illness among travellers and has overtaken malaria as the leading cause of febrile illness for those traveling to Southeast Asia. The purpose is to review the risk of dengue and severe dengue in travellers with a particular focus on the pathogenesis and clinical management of severe dengue. RISK, PATHOGENESIS AND CLINICAL MANAGEMENT The risk of travel-acquired dengue depends on destination, season and duration of travel and activities during travel. Seroconversion rates reported in travellers, therefore, vary between <1% and >20%. The most common life-threatening clinical response to dengue infection is the dengue vascular permeability syndrome, epidemiologically linked to secondary infection, but can also occur in primary infection. Tertiary and quaternary infections are usually associated with mild or no disease. Antibody-dependent enhancement, viral factors, age, host factors and clinical experience of the managing physician modulate the risk of progressing to severe dengue. The relative risk of severe dengue in secondary versus primary infection ranges from 2 to 7. The absolute risk of severe dengue in children in highly endemic areas is ~0.1% per year for primary infections and 0.4% for secondary infections. About 2-4% of secondary infections lead to severe dengue. Severe dengue and death are both relatively rare in general travellers but more frequently in those visiting friends and relatives. Clinical management of severe dengue depends on judicious use of fluid rehydration. CONCLUSIONS Although dengue is a frequent cause of travel illness, severe dengue and deaths are rare. Nevertheless, dengue infections can interrupt travel and lead to evacuation and major out-of-pocket costs. Dengue is more frequent than many other travel-related vaccine preventable diseases, such as hepatitis A, hepatitis B, rabies, Japanese encephalitis and yellow fever, indicating a need for a dengue vaccine for travellers.
Collapse
Affiliation(s)
- Scott Halstead
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
9
|
Abstract
Dengue has become a major global public health threat with almost half of the world's population living in at-risk areas. Vaccination would likely represent an effective strategy for the management of dengue disease in endemic regions, however to date there is only one licensed preventative vaccine for dengue infection. The development of a vaccine against dengue virus (DENV) has been hampered by an incomplete understanding of protective immune responses against DENV. The most clinically advanced dengue vaccine is the chimeric yellow fever-dengue vaccine (CYD) that employs the yellow fever virus 17D strain as the replication backbone (Chimerivax-DEN; CYD-TDV). This vaccine had an overall pooled protective efficacy of 65.6% but was substantially more effective against severe dengue and dengue hemorrhagic fever. Several other vaccine approaches have been developed including live attenuated chimeric dengue vaccines (DENVax and LAV Delta 30), DEN protein subunit V180 vaccine (DEN1-80E) and DENV DNA vaccines. These vaccines have been shown to be immunogenic in animals and also safe and immunogenic in humans. However, these vaccines are yet to progress to phase III trials to determine their protective efficacy against dengue. This review will summarize the details of vaccines that have progressed to clinical trials in humans.
Collapse
Affiliation(s)
- J Torresi
- a Department of Microbiology and Immunology , The Peter Doherty Institute for Infection and Immunity, University of Melbourne , Parkville , Victoria , Australia
| | - G Ebert
- b The Walter and Eliza Hall Institute of Medical Research , Parkville , Victoria , Australia
| | - M Pellegrini
- b The Walter and Eliza Hall Institute of Medical Research , Parkville , Victoria , Australia.,c Department of Medical Biology , The University of Melbourne , Parkville , Victoria , Australia
| |
Collapse
|
10
|
Orellano PW, Salomón OD. [Dengue vaccines. A reality for Argentina?]. Medicina (B Aires) 2016; 76:98-102. [PMID: 27028058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Dengue outbreaks have occurred yearly in Argentina since 1998. A number of candidate vaccines have been tested in endemic countries. The most advanced one was licensed in three countries of Latin America for children over 9 years of age. In the present article the benefits and drawbacks of these vaccines as well as the challenges for the implementation of a vaccination strategy in Argentina are discussed. Furthermore, a risk stratification strategy with new criteria and a multidisciplinary vision is suggested as a possible path for the assessment of the pertinence of a vaccination program in areas showing the highest risk of dengue transmission and/or for people at the greatest risk of developing severe dengue. It is also suggested that the definition regarding the status of endemicity should take into account the local realities. Finally, this paper proposes a broad discussion on the evidences, the expected impact and instrumental aspects that would be involved in the incorporation of a dengue vaccine, marketed or in development, into the national immunization program, and especially which subpopulation should be targeted for the immunization strategy to be cost-effective.
Collapse
Affiliation(s)
- Pablo W Orellano
- Universidad Tecnológica Nacional, Facultad Regional San Nicolás, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina. E-mail:
| | - Oscar D Salomón
- Instituto Nacional de Medicina Tropical (INMeT), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Puerto Iguazú, Misiones, Argentina
| |
Collapse
|
11
|
Abstract
Dengue is a major public health concern in tropical and subtropical areas of the world. The prospects for dengue prevention have recently improved with the results of efficacy trials of a tetravalent dengue vaccine. Although partially effective, once licensed, its introduction can be a public health priority in heavily affected countries because of the perceived public health importance of dengue. This review explores the most immediate economic considerations of introducing a new dengue vaccine and evaluates the published economic analyses of dengue vaccination. Findings indicate that the current economic evidence base is of limited utility to support country-level decisions on dengue vaccine introduction. There are a handful of published cost-effectiveness studies and no country-specific costing studies to project the full resource requirements of dengue vaccine introduction. Country-level analytical expertise in economic analyses, another gap identified, needs to be strengthened to facilitate evidence-based decision-making on dengue vaccine introduction in endemic countries.
Collapse
Affiliation(s)
- Yesim Tozan
- a College of Global Public Health , New York University , New York , NY , USA
| |
Collapse
|
12
|
Abstract
Dengue is a mosquito-borne disease which is currently an expanding global health problem. The disease is caused by four closely related viruses, the dengue virus. There are no specific dengue therapeutics and prevention is currently limited to vector control measures. Development of an effective tetravalent dengue vaccine would therefore represent a major advance in the control of the disease and is considered a high public health priority. While a licensed dengue vaccine is not yet available, the scope and intensity of dengue vaccine development has increased dramatically in the last decade. The uniqueness of the dengue viruses and the spectrum of disease resulting from infection have made dengue vaccine development difficult. Several vaccine candidates are currently being evaluated in clinical studies. The candidate currently at the most advanced clinical development stage, a live-attenuated tetravalent vaccine based on chimeric yellow fever dengue virus, has progressed to phase III efficacy studies. Several other live-attenuated vaccines, as well as subunit, DNA and purified inactivated vaccine candidates, are at earlier stages of clinical development. Additional technological approaches, such as virus-vectored and virus-like particle-based vaccines, are under evaluation in preclinical studies.
Collapse
Affiliation(s)
- Usa Thisyakorn
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Bangkok 10330, Thailand
| | - Chule Thisyakorn
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
13
|
Crill WD, Hughes HR, Trainor NB, Davis BS, Whitney MT, Chang GJJ. Sculpting humoral immunity through dengue vaccination to enhance protective immunity. Front Immunol 2012; 3:334. [PMID: 23162552 PMCID: PMC3492872 DOI: 10.3389/fimmu.2012.00334] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/20/2012] [Indexed: 11/13/2022] Open
Abstract
Dengue viruses (DENV) are the most important mosquito transmitted viral pathogens infecting humans. DENV infection produces a spectrum of disease, most commonly causing a self-limiting flu-like illness known as dengue fever; yet with increased frequency, manifesting as life-threatening dengue hemorrhagic fever (DHF). Waning cross-protective immunity from any of the four dengue serotypes may enhance subsequent infection with another heterologous serotype to increase the probability of DHF. Decades of effort to develop dengue vaccines are reaching the finishing line with multiple candidates in clinical trials. Nevertheless, concerns remain that imbalanced immunity, due to the prolonged prime-boost schedules currently used in clinical trials, could leave some vaccinees temporarily unprotected or with increased susceptibility to enhanced disease. Here we develop a DENV serotype 1 (DENV-1) DNA vaccine with the immunodominant cross-reactive B cell epitopes associated with immune enhancement removed. We compare wild-type (WT) with this cross-reactivity reduced (CRR) vaccine and demonstrate that both vaccines are equally protective against lethal homologous DENV-1 challenge. Under conditions mimicking natural exposure prior to acquiring protective immunity, WT vaccinated mice enhanced a normally sub-lethal heterologous DENV-2 infection resulting in DHF-like disease and 95% mortality in AG129 mice. However, CRR vaccinated mice exhibited redirected serotype-specific and protective immunity, and significantly reduced morbidity and mortality not differing from naїve mice. Thus, we demonstrate in an in vivo DENV disease model, that non-protective vaccine-induced immunity can prime vaccinees for enhanced DHF-like disease and that CRR DNA immunization significantly reduces this potential vaccine safety concern. The sculpting of immune memory by the modified vaccine and resulting redirection of humoral immunity provide insight into DENV vaccine-induced immune responses.
Collapse
Affiliation(s)
- Wayne D Crill
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Service Fort Collins, CO, USA
| | | | | | | | | | | |
Collapse
|