Pre-vaccination screening strategies for the use of the CYD-TDV dengue vaccine: A meeting report

The first licensed dengue vaccine, CYD-TDV (Dengvaxia) is efficacious in seropositive individuals, but increases the risk for severe dengue in seronegative persons about two years after administration of the first dose. For countries considering the introduction of Dengvaxia, WHO recommends a pre-va...

Full description

Saved in:
Bibliographic Details
Published in:Vaccine 2019-08, Vol.37 (36), p.5137-5146
Main Authors: Wilder-Smith, A., Smith, P.G., Luo, R., Kelly-Cirino, C., Curry, D., Larson, H., Durbin, A., Chu, M., Tharmaphornpilas, P., Ng, L.C., Sartori, A.M.C., Luna, E.J.A., Gubler, D.J., España, G., Yoon, I.K., Flasche, S.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age
Antibodies, Viral - immunology
Automation
Brazil
Child
Combined vaccines
Communication
Connectivity
Consortia
Dengue
Dengue - immunology
Dengue - microbiology
Dengue - prevention & control
Dengue fever
Dengue hemorrhagic fever
Dengue Vaccines - immunology
Dengue Vaccines - therapeutic use
Dengue Virus
Diagnostic tests
Disease transmission
Dosage
Ethics
Humans
Humidity
Immunization
Immunization Programs - methods
Immunoglobulins
Infections
Laboratories
Licenses
Logistics
Medical diagnosis
Medical ethics
Medical research
Mosquitoes
National vaccination programmes
Pertussis
Philippines
Process controls
Public Health
Rapid diagnostic tests
Risk
Schedules
Screening
Seroepidemiologic Studies
Serology
Tetanus
Vaccine hesitancy
Vaccines
Vaccines, Attenuated - therapeutic use
Vector-borne diseases
Viral diseases
WHO
World Health Organization
Young Adult
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The first licensed dengue vaccine, CYD-TDV (Dengvaxia) is efficacious in seropositive individuals, but increases the risk for severe dengue in seronegative persons about two years after administration of the first dose. For countries considering the introduction of Dengvaxia, WHO recommends a pre-vaccination screening strategy whereby only persons with evidence of a past dengue infection would be vaccinated. Policy-makers need to consider the risk-benefit of vaccination strategies based on such screening tests, the optimal age to introduce the vaccine, communication and implementation strategies. To address these questions, the Global Dengue and Aedes-transmitted diseases Consortium (GDAC) organized a 3-day workshop in January 2019 with country representatives from Asia and Latin America. The meeting discussions highlighted many challenges in introducing Dengvaxia, in terms of screening test characteristics, costs of such tests combined with a 3-dose schedule, logistics, achieving high coverage rates, vaccine confidence and communication; more challenges than for any other vaccine introduction programme. A screening test would require a high specificity to minimize individual risk, and at the same time high sensitivity to maximize individual and population benefit. The underlying seroprevalence dependent positive predictive value is the best indicator for an acceptable safety profile of a pre-vaccination screening strategy. The working groups discussed many possible implementation strategies. Addressing the bottlenecks in school-based vaccine introduction for Dengvaxia will also benefit other vaccines such as HPV and booster doses for tetanus and pertussis. Levels of public trust are highly variable and context specific, and understanding of population perceptions and concerns is essential to tailor interventions, monitor and mitigate risks.
ISSN:0264-410X
1873-2518
DOI:10.1016/j.vaccine.2019.07.016