The Centers for Disease Control and Prevention (CDC) has created a comprehensive guide for pediatricians on the first U.S. dengue vaccine as well as the disease itself, as infections are expected to increase.
The CDC recommends Dengvaxia vaccine from Sanofi Pasteur Inc. for children ages 9-16 years who live in endemic areas. However, recipients must have laboratory confirmation of a previous dengue infection.
“Although advancements in the field have progressed incrementally for decades, the recent approval of Dengvaxia for routine use marks a major step forward for control and prevention efforts in the United States and paves the way for future dengue vaccines,” authors wrote in “Dengue: A Growing Problem with New Interventions,” (Wong JM, et al. Pediatrics. May 11, 2022).
Dengvaxia is a live vaccine that can be used to prevent all four types of dengue, a virus transmitted by Aedes mosquitoes. It is given in a series of three doses six months apart and has an efficacy of 82% against symptomatic dengue infection and 79% against hospitalization.
Vaccine administration is complicated because giving the vaccine to children who have never had dengue puts them at increased risk of severe disease and hospitalization if they subsequently get infected. Therefore, children will need to be screened before vaccination using tests with high levels of sensitivity and specificity to confirm previous infection. The Pediatrics article has in-depth information on the types of pre-vaccination lab tests that can be used, as does the CDC’s website.
The most common vaccine side effects in trials were headache, injection site pain, malaise, asthenia and myalgia. Over a 10-year period, Dengvaxia is expected to prevent more than 4,000 symptomatic cases of dengue and nearly 3,000 hospitalizations, according to the CDC report. About 51 hospitalizations are likely to result from vaccination of people without previous dengue infection.
The report also includes information about two additional dengue vaccines that are in late-stage trials.
CDC experts warn about increasing rates of infection driven by climate change, urbanization, travel and poverty. Dengue already is the world’s most common arboviral disease, causing about 390 million infections annually. The virus is endemic in U.S. territories and freely associated states, including American Samoa, Puerto Rico, U.S. Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands and the Republic of Palau. Cases also have been seen in Florida, Hawaii and Texas in recent years.
The most common symptoms include fever accompanied by nausea, vomiting, rash, myalgias, arthralgias, retroorbital pain, headache and/or leukopenia. About 5% of infections result in severe disease. In addition to vaccination, people can protect themselves by taking steps to avoid mosquito bites. The Pediatrics article has more in-depth information on epidemiology, clinical features, tests, treatment and prevention.