Dengue vaccines: implications for dengue control

Recent Advancements in Mosquito-Borne Flavivirus Vaccine Development

Lately, the global incidence of flavivirus infection has been increasing dramatically and presents formidable challenges for public health systems around the world. Most clinically significant flaviviruses are mosquito-borne, such as the four serotypes of dengue virus, Zika virus, West Nile virus, Japanese encephalitis virus and yellow fever virus. Until now, no effective antiflaviviral drugs are available to fight flaviviral infection; thus, a highly immunogenic vaccine would be the most effective weapon to control the diseases. In recent years, flavivirus vaccine research has made major breakthroughs with several vaccine candidates showing encouraging results in preclinical and clinical trials. This review summarizes the current advancement, safety, efficacy, advantages and disadvantages of vaccines against mosquito-borne flaviviruses posing significant threats to human health.

Isobaric tags for relative and absolute quantification-based proteomic analysis of host-pathogen protein interactions in the midgut of Aedes albopictus during dengue virus infection

Aedes albopictus (Ae. albopictus), an important vector of dengue virus (DENV), is distributed worldwide. Identifying host proteins involved in flavivirus replication in Ae. albopictus and determining their natural antiviral mechanisms are critical to control virus transmission. Revealing the key proteins related to virus replication and exploring the host-pathogen interaction are of great significance in finding new pathways of the natural immune response in Ae. albopictus. Isobaric tags for relative and absolute quantification (iTRAQ) was used to perform a comparative proteomic analysis between the midgut of Ae. albopictus infected with DENV and the control. 3,419 proteins were detected, of which 162 were ≥ 1.2-fold differentially upregulated or ≤ 0.8-fold differentially downregulated (p < 0.05) during DENV infections. Differentially expressed proteins (DEPs) were mainly enriched in ubiquitin ligase complex, structural constituent of cuticle, carbohydrate metabolism, and lipid metabolism pathways. We found that one of the DEPs, a putative pupal cuticle (PC) protein could inhibit the replication of DENV and interact with the DENV-E protein. In addition, the result of immunofluorescence (IF) test showed that there was co-localization between ubiquitin carboxyl-terminal hydrolase (UCH) protein and the DENV-E protein, and virus infection reduced the level of this protein. iTRAQ-based proteomic analysis of the Ae. albopictus midgut identified dengue infection-induced upregulated and downregulated proteins. The interaction between the PC and UCH proteins in the midgut of Ae. albopictus might exert a natural antiviral mechanism in mosquito.

Spatial heterogeneity of knockdown resistance mutations in the dengue vector Aedes albopictus in Guangzhou, China

Background

The city of Guangzhou has been the epicenter of dengue fever in China since the 1990s, with Aedesalbopictus being the primary vector. The main method used to control vectors and prevent dengue fever has been the application of chemical insecticides; however, this control strategy has resulted in the development of resistance to these insecticides in mosquitoes. Here we report our investigation of the patterns of knockdown resistance (kdr) mutations in 15 field populations of Ae.albopictus collected from 11 districts in Guangzhou.

Results

Four mutant alleles (V1016G, F1534S, F1534C, F1534L) were detected in domain II and III of the voltage-gated sodium channel (VGSC) gene. Various allele frequencies of kdr mutations were observed (3.1–25.9% for V1016G, 22.6–85.5% for F1534S, 0–29.0% for F1534L, 0.6–54.2% for F1534C). Seven kdr haplotypes (VF, VS, VL, VC, GF, GC, GS) were identified; the highest frequency of haplotypes was found for the single mutant haplotype VS (50.8%), followed by the wild-type VF haplotype (21.7%) and the single mutant haplotype VC (11.9%). Of the three double mutant haplotypes, GF was the most frequent (8.8%), followed by GC (1.2%) and GS (0.8%). Aedesalbopictus showed spatial heterogeneity in deltamethrin resistance in populations collected in Guangzhou. We also observed significant differences in haplotype frequency. The frequency of the VC haplotype was significantly higher in high-risk dengue areas than in low-risk ones.

Conclusions

The kdr allele V1016G was discovered for the first time in Guangzhou. Genetic isolation in mosquito populations and long-term insecticide selection seem to be responsible for the persistent, patchy distribution of kdr mutant alleles. The small-scale spatial heterogeneity in the distribution and frequency of kdr mutations may have important implications for vector control operations and insecticide resistance management strategies.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05241-7.

Effects of Guangzhou seasonal climate change on the development of Aedes albopictus and its susceptibility to DENV-2

The susceptibility of Asian tiger mosquitoes to DENV-2 in different seasons was observed in simulated field environments as a reference to design dengue fever control strategies in Guangzhou. The life table experiments of mosquitoes in four seasons were carried out in the field. The susceptibility of Ae. albopictus to dengue virus was observed in both environments in Guangzhou in summer and winter. Ae. albopictus was infected with dengue virus by oral feeding. On day 7 and 14 after infection, the viral load in the head, ovary, and midgut of the mosquito was detected using real-time fluorescent quantitative PCR. Immune-associated gene expression in infected mosquitoes was performed using quantitative real-time reverse transcriptase PCR. The hatching rate and pupation rate of Ae. albopictus larvae in different seasons differed significantly. The winter hatching rate of larvae was lower than that in summer, and the incubation time was longer than in summer. In the winter field environment, Ae. albopictus still underwent basic growth and development processes. Mosquitoes in the simulated field environment were more susceptible to DENV-2 than those in the simulated laboratory environment. In the midgut, viral RNA levels on day 7 in summer were higher than those on day 7 in winter (F = 14.459, P = 0.01); ovarian viral RNA levels on day 7 in summer were higher than those on day 7 in winter (F = 8.656, P < 0.001), but there was no significant difference in the viral load at other time points (P > 0.05). Dicer-2 mRNA expression on day 7 in winter was 4.071 times than that on day 7 in summer: the viral load and Dicer-2 expression correlated moderately. Ae. albopictus could still develop and transmit dengue virus in winter in Guangzhou. Mosquitoes under simulated field conditions were more susceptible to DENV-2 than those under simulated laboratory conditions.

Modeling spatial pattern of dengue in North Central Mexico using survey data and logistic regression

Dengue is a major public health concern mainly in tropical and subtropical environments worldwide. Despite several attempts to prevent this disease occurring in tropical regions of Mexico, it has not yet been controlled. This work focused on spatial modeling of confirmed dengue fever cases that occurred during the period 2010-2014 in the Huasteca Potosina region of Mexico. Multivariable Logistic Regression Modeling (MLRM) was used to determine the relationship between explanatory variables and the presence/absence of dengue. Model performance was evaluated using the area under curve (AUC) of the relative operating characteristic (ROC); AUC > 0.95. A high spatial resolution map was created to reveal the most probable patterns of dengue risk. Our results can be used for targeted control and prevention programs at local and regional levels. This methodology can be applied to other major diseases that are spatially distributed in accordance with environmental factors.

In Silico Prediction of the Phosphorylation of NS3 as an Essential Mechanism for Dengue Virus Replication and the Antiviral Activity of Quercetin

Simple Summary

Dengue is a mosquito-borne virus that infects up to 400 million people worldwide annually. Dengue infection triggers high fever, severe body aches, rash, low platelet count, and could lead to Dengue hemorrhagic fever (DHF) in some cases. There is currently no cure, nor a broadly effective vaccine. The interaction of two viral proteins, nonstructural Proteins 3 and 5 (NS3 and NS5), is required for viral replication in the infected host’s cells. Our computational modeling of NS3 suggested that phosphorylation of a serine residue at position 137 of NS3 by a specific c-Jun N-terminal kinase (JNK) enhances viral replication by increasing the interaction of NS3 and NS5 through structural changes in amino acid residues 49–95. Experimental studies have shown that inhibition of JNK prevents viral replication and have suggested that the plants’ flavonoid Quercetin, Agathis flavone, and Myricetin inhibit Dengue infection. Our molecular simulations revealed that Quercetin binds NS3 and obstructs serine 137 phosphorylation, which may decrease viral replication. This work offers a molecular mechanism that can be used for anti-Dengue drug development.

Abstract

Dengue virus infection is a global health problem for which there have been challenges to obtaining a cure. Current vaccines and anti-viral drugs can only be narrowly applied in ongoing clinical trials. We employed computational methods based on structure-function relationships between human host kinases and viral nonstructural protein 3 (NS3) to understand viral replication inhibitors’ therapeutic effect. Phosphorylation at each of the two most evolutionarily conserved sites of NS3, serine 137 and threonine 189, compared to the unphosphorylated state were studied with molecular dynamics and docking simulations. The simulations suggested that phosphorylation at serine 137 caused a more remarkable structural change than phosphorylation at threonine 189, specifically located at amino acid residues 49–95. Docking studies supported the idea that phosphorylation at serine 137 increased the binding affinity between NS3 and nonstructural Protein 5 (NS5), whereas phosphorylation at threonine 189 decreased it. The interaction between NS3 and NS5 is essential for viral replication. Docking studies with the antiviral plant flavonoid Quercetin with NS3 indicated that Quercetin physically occluded the serine 137 phosphorylation site. Taken together, these findings suggested a specific site and mechanism by which Quercetin inhibits dengue and possible other flaviviruses.

Evaluation of a mosquito home system for controlling Aedes aegypti

BACKGROUND

Dengue is a significant public health issue that is caused by Aedes spp. mosquitoes. The current vector control methods are unable to effectively reduce Aedes populations and thus fail to decrease dengue transmission. Hence, there is an urgent need for new tools and strategies to reduce dengue transmission in a wide range of settings. In this study, the Mosquito Home System (MHS) and Mosquito Home Aqua (MHAQ) formulations were assessed as commercial autodissemination traps in laboratory and small-scale field trials.

METHOD

Multiple series of laboratory and small-scale field trials were performed to assess the efficacy of MHS and MHAQ exposed to Ae. aegypti. In the laboratory trials, various parameters such as fecundity, fertility, wing size, oviposition preferences, residual effects, and MHAQ transference to other containers through controlled experiments were tested. For small-scale field trials, the efficacy of the MHS and MHAQ approaches was determined to ascertain whether wild mosquitoes could transfer the MHAQ formulation from MHS stations to ovitraps.

RESULTS

The data revealed that Ae. aegypti was highly susceptible to low concentrations of MHAQ formulations and had a residual effect of up to 3 months, with MHAQ exposure affecting fecundity, fertility, and mosquito wing size. In the oviposition studies, gravid females strongly preferred the hay infusion compared to tap water and MHAQ during egg-laying in the laboratory. Nevertheless, the use of commercial MHAQ by MHS was highly attractive in field settings compared to conventional ovitraps among local Aedes spp. mosquitoes. In addition, MHAQ horizontal transfer activities in the laboratory and small-scale field trials were demonstrated through larval bioassays. These findings demonstrated the potential of MHAQ to be transferred to new containers in each study site.

CONCLUSION

This study provided proof of principle for the autodissemination of MHAQ. Through further refinement, this technique and device could become an effective oviposition trap and offer an alternative preventive tool for vector control management.

The Global Trends and Regional Differences in Incidence of Dengue Infection from 1990 to 2019: An Analysis from the Global Burden of Disease Study 2019

Introduction

Dengue, as a neglected tropical disease, brings a heavy socioeconomic burden. To provide tailored global prevention strategies, we analyzed the global trends and regional differences in incidence of dengue infection from 1990 to 2019.

Methods

We obtained data on annual dengue episodes and incidence rates, which reflected the epidemic status of dengue infection from the 2019 Global Burden of Disease (GBD) Study. The changes in dengue episodes and estimated annual percentage changes (EAPCs) of the age-standardized incidence rate (ASR) were calculated to quantify the temporal trends of dengue infection.

Results

Globally, dengue ASR increased by 1.70% (95% CI 1.62%–1.78%) per year from 1990 to 2011; subsequently, it decreased by 0.41% (95% CI 0.20%–0.62%) per year from 2011 to 2019. However, the global number of dengue episodes increased steadily by 85.47% from 30.67 million in 1990 to 56.88 million in 2019. Against the global trend of decreasing ASR from 2011 to 2019, an increasing trend was reported in Oceania (EAPC 11.01, 95% CI 8.79–13.27), East Asia (EAPC 4.84, 95% CI 2.70–7.03) and Southeast Asia (EAPC 0.38, 95% CI 0.13–0.62). For socio-demographic index (SDI) regions, ASR continued to have an increasing trend in the middle (EAPC 0.26, 95% CI 0.07–0.45) and high-middle (EAPC 1.70, 95% CI 0.98–2.42) SDI regions from 2011 to 2019. In contrast to the global peak age of dengue incidence rate (10 to 25 years), the dengue incidence rate of older people (> 65 years) was higher than in other age groups in low and low-middle SDI regions. Additionally, the proportions of dengue episodes in the > 70-year-old age group increased in 2019 (using the baseline in 1990 or 2011) in most GBD regions.

Conclusions

Global dengue episodes have increased tremendously in 3 decades. Although global dengue ASR decreased in the last decade, it is still increasing in hyperendemic regions including Oceania, East Asia and Southeast Asia, and also in the middle and high-middle SDI regions. More attention should be paid to the elderly because of the higher dengue incidence rate among them in low and low-middle SDI regions and the increased proportions of dengue episodes among the elderly in most GBD regions. Therefore, more efforts should be undertaken to develop targeted prevention strategies for crucial regions and older populations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40121-021-00470-2.

Aedes aegypti SNAP and a calcium transporter ATPase influence dengue virus dissemination

Dengue virus (DENV) is a flavivirus that causes marked human morbidity and mortality worldwide, and is transmitted to humans by Aedes aegypti mosquitoes. Habitat expansion of Aedes, mainly due to climate change and increasing overlap between urban and wild habitats, places nearly half of the world's population at risk for DENV infection. After a bloodmeal from a DENV-infected host, the virus enters the mosquito midgut. Next, the virus migrates to, and replicates in, other tissues, like salivary glands. Successful viral transmission occurs when the infected mosquito takes another blood meal on a susceptible host and DENV is released from the salivary gland via saliva into the skin. During viral dissemination in the mosquito and transmission to a new mammalian host, DENV interacts with a variety of vector proteins, which are uniquely important during each phase of the viral cycle. Our study focuses on the interaction between DENV particles and protein components in the A. aegypti vector. We performed a mass spectrometry assay where we identified a set of A. aegypti salivary gland proteins which potentially interact with the DENV virion. Using dsRNA to silence gene expression, we analyzed the role of these proteins in viral infectivity. Two of these candidates, a synaptosomal-associated protein (AeSNAP) and a calcium transporter ATPase (ATPase) appear to play a role in viral replication both in vitro and in vivo, observing a ubiquitous expression of these proteins in the mosquito. These findings suggest that AeSNAP plays a protective role during DENV infection of mosquitoes and that ATPase protein is required for DENV during amplification within the vector.

T lymphocyte responses to flaviviruses - diverse cell populations affect tendency toward protection and disease

Dengue virus (DENV), Yellow Fever virus, West Nile virus, Japanese encephalitis virus and Zika virus are medically important flaviviruses transmitted to humans by mosquitoes and circulate in overlapping geographic areas. Cross-reactive immune responses have been demonstrated among the flaviviruses, particularly the four DENV serotypes. The immunological imprint left by a flavivirus infection can therefore have profound effects on the responses to subsequent infections. In this review we summarize recent research focusing on T cell responses to DENV using clinical samples from prospective cohort studies in Asia. These data suggest that durability of different T cell populations after natural infection or vaccination is an important consideration for the outcome of subsequent flavivirus exposures and we argue for continued investigation in the context of longitudinal cohort studies.

Vector competence of Aedes aegypti from New Caledonia for the four recent circulating dengue virus serotypes

In New Caledonia (NC), Aedes aegypti is the only proven vector of dengue virus (DENV), which is the most prevalent arbovirosis in NC. Since World War II, the four DENV serotypes have circulated regularly in NC. The epidemiological profile, however, has evolved over the last ten years, with the persistence of DENV-1 circulation and the co-circulation of several DENV serotypes. The current study evaluated the ability of Ae. aegypti from NC to transmit four DENV serotypes (and two DENV-1 genotypes) isolated during recent outbreaks in NC. An Ae. aegypti F1 generation was twice independently orally challenged with each DENV strain (10⁷ FFU/ml). Infection, dissemination and transmission rates and transmission efficiency were measured at day 7 and 14 post-exposure, as well as the quantity of infectious virus particles. Mosquito infection was observed as early as 7 days post-infection. Infection rates between 18 and 58% were measured for all DENV serotypes/genotypes tested. Although dissemination rates ranged from 78 to 100%, transmission efficiencies were low, with values not exceeding 21% at 14 days post-infection for all DENV strains. This study shows that NC Ae. aegypti are moderately competent for DENV in laboratory conditions. In link with epidemiological data, these results suggest implication of other factors in the sustained circulation of DENV-1 in New Caledonia.

Aedes aegypti is the only known vector for dengue virus (DENV) in New Caledonia (NC). DENV are divided into four serotypes (DENV-1 to -4), based on their antigenic properties, these being subdivided into different genotypes. All four DENV serotypes have regularly circulated in New Caledonia in the past. An unusual persistence of DENV-1 has been observed during the last ten years, suggesting a possible preferential transmission of this DENV serotype by Ae. aegypti. In this study, we examine for the first time the ability of Ae. aegypti from New Caledonia to transmit the four circulating DENV serotypes, and more precisely two genotypes of DENV-1. Our results demonstrate that this vector is moderately competent for DENV, with slight differences observed between DENV serotype/genotype in terms of transmission. These findings suggest that other factors are at play in the sustained circulation of DENV-1 and that further vector-virus interactions studies should be undertaken to better understand the DENV epidemiological profile in NC.

Optimal control approaches for combining medicines and mosquito control in tackling dengue

Dengue is a debilitating and devastating viral infection spread by mosquito vectors, and over half the world's population currently live at risk of dengue (and other flavivirus) infections. Here, we use an integrated epidemiological and vector ecology framework to predict optimal approaches for tackling dengue. Our aim is to investigate how vector control and/or vaccination strategies can be best combined and implemented for dengue disease control on small networks, and whether these optimal strategies differ under different circumstances. We show that a combination of vaccination programmes and the release of genetically modified self-limiting mosquitoes (comparable to sterile insect approaches) is always considered the most beneficial strategy for reducing the number of infected individuals, owing to both methods having differing impacts on the underlying disease dynamics. Additionally, depending on the impact of human movement on the disease dynamics, the optimal way to combat the spread of dengue is to focus prevention efforts on large population centres. Using mathematical frameworks, such as optimal control, are essential in developing predictive management and mitigation strategies for dengue disease control.

Microbiota potentialized larvicidal action of imidazolium salts against Aedes aegypti (Diptera: Culicidae)

Mosquitoes are important vectors of pathogens due to their blood feeding behavior. Aedes aegypti (Diptera: Culicidae) transmits arboviruses, such as dengue, Zika, and Chikungunya. This species carries several bacteria that may be beneficial for its biological and physiological development. Therefore, studying the response of its microbiota to chemical products could result in vector control. Recently, imidazolium salts (IS) were identified as effective Ae. aegypti larvicides. Considering the importance of the mosquito microbiota, this study addressed the influence of IS on the bacteria of Ae. aegypti larvae. After exposition of larvae to different IS concentrations, the cultured microbiota was identified through culturomics and mass spectrometry, and the non-cultivated microbiota was characterized by molecular markers. In addition, the influence of the IS on axenic larvae was studied for comparison. There was an alteration in both cultivable species and in their diversity, including modifications in bacterial communities. The axenic larvae were less susceptible to the IS, which was increased after exposing these larvae to bacteria of laboratory breeding water. This highlights the importance of understanding the role of the larval microbiota of Ae. aegypti in the development of imidazolium salt-based larvicides. Such effect of IS towards microbiota of Ae. aegypti larvae, through their antimicrobial action, increases their larvicidal potential.

The use of air travel data for predicting dengue importation to China: A modelling study

BACKGROUND

Dengue virus importation from abroad is still the main driver of dengue incidence in China. Using global flight data to model importation may improve our understanding and prediction of dengue virus importation and onward transmission.

METHODS

A retrospective analysis was performed of surveillance cases of dengue infections imported to China and volume of air traffic to China for the years 2005 through 2014, inclusive. The data were aggregated by year, destination province, and source country. Descriptive statistics were calculated, and a random effects negative binomial model was created to predict the number of imported cases based on the volume of travelers from dengue-endemic countries.

RESULTS

There were 1,822 cases of imported dengue infections over the study period. Most imported cases are from a small number of high-incidence countries with a large volume of travel to China, most notably Myanmar (22% of cases). The number of imported cases of dengue infections increased by 5.9% for every 10% increase in travel volume from dengue-endemic countries.

CONCLUSION

Patterns of air travel have a measurable impact on the importation of dengue to China. Modelling dengue importation risk may be a useful strategy to direct public health surveillance and interventions.

Discovery of Indole Derivatives as Novel and Potent Dengue Virus Inhibitors

3-Acyl-indole derivative 1 was identified as a novel dengue virus (DENV) inhibitor from a DENV serotype 2 (DENV-2) phenotypic antiviral screen. Extensive SAR studies led to the discovery of new derivatives with improved DENV-2 potency as well as activity in nanomolar to micromolar range against the other DENV serotypes. In addition to the potency, physicochemical properties and metabolic stability in rat and human microsomes were improved during the optimization process. Chiral separation of the racemic mixtures showed a clear preference for one of the two enantiomers. Furthermore, rat pharmacokinetics of two compounds will be discussed in more detail, demonstrating the potential of this new series of pan-serotype-DENV inhibitors.

Assessment of benefits and risks associated with dengue vaccination at the individual and population levels: a dynamic modeling approach

BACKGROUND

A case-cohort study, using a novel assay and data from three dengue vaccine efficacy trials, highlighted differences in vaccination outcomes according to baseline serostatus. Based on these results, we explored, with a model, the benefits and risks associated with vaccination.

RESEARCH DESIGN AND METHODS

Parameters of a previously developed transmission model were estimated with subject-level data from a case-cohort study. The model was used to assess vaccination outcomes for a range of transmission settings over 5-30 years, with or without indirect protection.

MAIN OUTCOME MEASURES

Symptomatic dengue cases, dengue hospitalizations, and severe dengue cases.

RESULTS

The model is consistent with previous results indicating a transitory period at increased risk for dengue-seronegative vaccine recipients (setting-dependent duration) and long-term benefits for dengue-seropositive recipients. At the population level, benefits to seropositive individuals over 10 years outweighed the risk to those seronegative in moderate to high transmission settings (≥50% seropositivity at age 9), especially in high transmission settings (no excess hospitalizations in dengue-seronegative for ≥80% seropositivity at age 9). Results were more favorable when longer time horizons or indirect protection were considered.

CONCLUSIONS

Results indicate a public health benefit associated with dengue vaccination especially in high-transmission settings, even with the initial excess risks to dengue-seronegative patients which diminish over time.

Humanized mouse models to study human cell-mediated and humoral responses to dengue virus

Several candidate dengue virus vaccines are in clinical trials and show promise as an effective measure to control dengue. However, it is becoming clear that additional vaccine candidates may be needed as there is concern about the durability of the immune response to all four serotypes of vaccine components and efficacy varies dependent on the immune status of the individual. The lack of an appropriate animal model to mimic human dengue has deterred the development of vaccines and anti-viral therapies to dengue virus. The focus of this review is to discuss advances in the development of humanized animal models and to highlight how they could be used for antiviral and dengue vaccine testing if limitations with cell-mediated immunity and seroconversion to IgG are overcome.