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Donadel M, Panero MS, Ametewee L, Shefer AM. National decision-making for the introduction of new vaccines: A systematic review, 2010-2020. Vaccine 2021; 39:1897-1909. [PMID: 33750592 PMCID: PMC10370349 DOI: 10.1016/j.vaccine.2021.02.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Competing priorities make using a transparent and evidence-based approach important when deciding to recommend new vaccines. We conducted a literature review to document the processes and frameworks for national decision-making on new vaccine introductions and explored which key features have evolved since 2010. METHODS We searched literature published on policymaking related to vaccine introduction from March 2010 to August 2020 in six databases. We screened articles for eligibility with the following exclusion criteria: non-human or hypothetical vaccines, the sole focus on economic evaluation or decision to adopt rather than policy decision-making. We employed nine broad categories of criteria from the 2012 review for categorization and abstracted data on the country, income level, vaccine, and other relevant criteria. RESULTS Of the 3808 unique references screened, 116 met eligibility criteria and were classified as: a) framework of vaccine adoption decision-making (27), b) studies that analyse empirical data on or examples of vaccine adoption decision-making (45), c) theoretical and empirical articles that provide insights into the vaccine policymaking process (44 + 17 already included in the previous categories). Commonly reported criteria for decision-making were the burden of disease; vaccine efficacy/effectiveness, safety; impact on health and non-health outcomes; economic evaluation and cost-effectiveness of alternative interventions. Programmatic and acceptability aspects were not as often considered. Most (50; 82%) of the 61 articles describing the process of vaccine introduction policymaking highlighted the role of country, regional, or global evidence-informed recommendations and a robust national governance as enabling factors for vaccine adoption. CONCLUSIONS The literature on vaccine adoption decision-making has expanded since 2010. We found that policymakers and expert advisory committee members (e.g., National Immunization Technical Advisory Group [NITAG]) increasingly value the interventions based on economic evaluations. The results of this review could guide discussions on evidence-informed immunization decision-making among country, sub-regional, and regional stakeholders.
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Affiliation(s)
- Morgane Donadel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Maria Susana Panero
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynnette Ametewee
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Abigail M Shefer
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Supadmi W, Suwantika AA, Perwitasari DA, Abdulah R. Economic Evaluations of Dengue Vaccination in the Southeast Asia Region: Evidence From a Systematic Review. Value Health Reg Issues 2019; 18:132-144. [DOI: 10.1016/j.vhri.2019.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 02/05/2019] [Accepted: 02/19/2019] [Indexed: 10/26/2022]
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Carabali M, Lim JK, Velez DC, Trujillo A, Egurrola J, Lee KS, Kaufman JS, DaSilva LJ, Velez ID, Osorio JE. Dengue virus serological prevalence and seroconversion rates in children and adults in Medellin, Colombia: implications for vaccine introduction. Int J Infect Dis 2017; 58:27-36. [PMID: 28284914 PMCID: PMC5421161 DOI: 10.1016/j.ijid.2017.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Dengue is an important public health problem worldwide. A vaccine has recently been licensed in some countries of Latin America and Asia. Recommendations for dengue vaccine introduction include endemicity and a high serological prevalence of dengue in the territories considering its introduction. METHODS A community-based survey was conducted to estimate dengue seroprevalence and age-specific seroconversion rates in a community in Medellin, Colombia, using a dengue serological test (IgG indirect ELISA). Residents were selected at random and were first screened for dengue infection; they were then followed over 2.5 years. RESULTS A total of 3684 individuals aged between 1 and 65 years participated in at least one survey. The overall dengue seroprevalence was 61%, and only 3.3% of seropositive subjects self-reported a past history of dengue. Among dengue virus (DENV)-naïve subjects with more than two visits (n=1002), the overall seroconversion rate was 8.7% (95% confidence interval 7.3-10.4) per 1000 person-months, over the study period. Overall, the mean age of DENV prevalent subjects was significantly higher than the mean age of seroconverted subjects. Specifically, DENV seropositivity over 70% was observed in participants over 21 years old. Serotype-specific plaque-reduction neutralization tests (PRNT) revealed that all four dengue serotypes were circulating, with DENV4 being most prevalent. CONCLUSIONS These laboratory-based findings could inform dengue vaccine decisions, as they provide age-specific seroprevalence and seroconversion data, evidencing permanent and ongoing dengue transmission in the study area. This study provides evidence for the existing rates of secondary and heterotypic responses, presenting a challenge that must be addressed adequately by the new vaccine candidates.
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Affiliation(s)
- Mabel Carabali
- Dengue Vaccine Initiative, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, South Korea; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Jacqueline Kyungah Lim
- Dengue Vaccine Initiative, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, South Korea
| | - Diana Carolina Velez
- Program for the Study and Control of Tropical Diseases, Universidad de Antioquia, Medellín, Colombia
| | - Andrea Trujillo
- Program for the Study and Control of Tropical Diseases, Universidad de Antioquia, Medellín, Colombia
| | - Jorge Egurrola
- Program for the Study and Control of Tropical Diseases, Universidad de Antioquia, Medellín, Colombia
| | - Kang Sung Lee
- Dengue Vaccine Initiative, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, South Korea
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Luiz Jacinto DaSilva
- Dengue Vaccine Initiative, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, South Korea
| | - Ivan Dario Velez
- Program for the Study and Control of Tropical Diseases, Universidad de Antioquia, Medellín, Colombia
| | - Jorge E Osorio
- Program for the Study and Control of Tropical Diseases, Universidad de Antioquia, Medellín, Colombia; Department of Pathobiological Sciences, University of Wisconsin, Madison, Wisconsin, USA
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Ladner J, Rodrigues M, Davis B, Besson MH, Audureau E, Saba J. Societal impact of dengue outbreaks: Stakeholder perceptions and related implications. A qualitative study in Brazil, 2015. PLoS Negl Trop Dis 2017; 11:e0005366. [PMID: 28278157 PMCID: PMC5344327 DOI: 10.1371/journal.pntd.0005366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 01/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background The growing burden of dengue in many countries worldwide and the difficulty of preventing outbreaks have increased the urgency to identify alternative public health management strategies and effective approaches to control and prevent dengue outbreaks. The objectives of this study were to understand the impact of dengue outbreak on different stakeholders in Brazil, to explore their perceptions of approaches used by governmental authorities to control and prevent dengue outbreaks and to define the challenges and implications of preventing future outbreaks. Methods In 2015, a qualitative study was conducted in two urban states in Brazil: São Paulo, which was experiencing an outbreak in 2015, and Rio de Janeiro, which experienced outbreaks in 2011 and 2012. Face-to-face interviews using a semi-structured questionnaire were conducted with nine different categories of stakeholders: health workers (physicians, nurses), hospital administrators, municipal government representatives, community members and leaders, school administrators, business leaders and vector control managers. Interviews were focused on the following areas: impact of the dengue outbreak, perceptions of control measures implemented by governmental authorities during outbreaks and challenges in preventing future dengue outbreaks. Results A total of 40 stakeholders were included in the study. Health workers and community members reported longer waiting times at hospitals due to the increased number of patients receiving care for dengue-related symptoms. Health workers and hospital administrators reported that there were no major interruptions in access to care. Overall financial impact of dengue outbreaks on households was greatest for low-income families. Despite prevention and control campaigns implemented between outbreak periods, various stakeholders reported that dengue prevention and control efforts performed by municipal authorities remained insufficient, suggesting that efforts should be reinforced and better coordinated by governmental authorities, particularly during outbreak periods. Conclusion The study shows that a dengue outbreak has a multisectorial impact in the medical, societal, economic and political sectors. The study provides useful insights and knowledge in different stakeholder populations that could guide local authorities and government officials in planning, designing and initiating public health programs. Research focused on a better understanding of how communities and political authorities respond to dengue outbreaks is a necessary component for designing and implementing plans to decrease the incidence and impact of dengue outbreaks in Brazil. Since the beginning of the 21st century, dengue fever has been a significant vector-borne arboviral disease; actually more than 3.9 billion people are at risk of infection in 128 countries. Dengue has become an increasing public health concern in Latin America, especially in Brazil, which has the highest incidence rate of dengue. Researches are needed to gain in-depth understanding of stakeholder and community reactions to outbreak and to explore the societal impact of dengue outbreaks. In 2015, a qualitative study was conducted in two urban states in Brazil, which experienced recent outbreaks. Longer waiting times at hospitals due to the increased number of patients receiving care for dengue-related symptoms were reported, but without interruptions in access to care. Various stakeholders reported that dengue prevention and control efforts performed by municipal authorities remained insufficient. The consequences of a dengue outbreak reach far beyond the patients, undermining medical, social, economic and political sectors. Research focused on a better understanding of how communities and political authorities respond to dengue outbreaks is a necessity for designing and implementing plans to control dengue outbreaks.
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Affiliation(s)
- Joël Ladner
- Rouen University Hospital, Epidemiology and Health Promotion Department, Rouen, France
- * E-mail: ,
| | | | | | | | - Etienne Audureau
- Paris Est University, Hôpital Henri Mondor Hospital, Public Health, Assistance Publique Hôpitaux de Paris, Créteil, France
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Carvalho A, Van Roy R, Andrus J. International Dengue Vaccine Communication and Advocacy: Challenges and Way Forward. Expert Rev Vaccines 2016; 15:539-45. [PMID: 26855170 DOI: 10.1586/14760584.2016.1152187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dengue vaccine introduction will likely occur soon. However, little has been published on international dengue vaccine communication and advocacy. More effort at the international level is required to review, unify and strategically disseminate dengue vaccine knowledge to endemic countries' decision makers and potential donors. Waiting to plan for the introduction of new vaccines until licensure may delay access in developing countries. Concerted efforts to communicate and advocate for vaccines prior to licensure are likely challenged by unknowns of the use of dengue vaccines and the disease, including uncertainties of vaccine impact, vaccine access and dengue's complex pathogenesis and epidemiology. Nevertheless, the international community has the opportunity to apply previous best practices for vaccine communication and advocacy. The following key strategies will strengthen international dengue vaccine communication and advocacy: consolidating existing coalitions under one strategic umbrella, urgently convening stakeholders to formulate the roadmap for integrated dengue prevention and control, and improving the dissemination of dengue scientific knowledge.
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Affiliation(s)
- Ana Carvalho
- a Sabin Vaccine Institute , Washington , DC , USA
| | | | - Jon Andrus
- a Sabin Vaccine Institute , Washington , DC , USA
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Abstract
In a Perspective, Jacqueline Deeen discusses challenges in balancing the individual and population risks and benefits for CYD-TDV (Dengvaxia), the first available dengue vaccine.
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Shi Y, Liu X, Kok SY, Rajarethinam J, Liang S, Yap G, Chong CS, Lee KS, Tan SS, Chin CKY, Lo A, Kong W, Ng LC, Cook AR. Three-Month Real-Time Dengue Forecast Models: An Early Warning System for Outbreak Alerts and Policy Decision Support in Singapore. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:1369-75. [PMID: 26662617 PMCID: PMC5010413 DOI: 10.1289/ehp.1509981] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 11/24/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND With its tropical rainforest climate, rapid urbanization, and changing demography and ecology, Singapore experiences endemic dengue; the last large outbreak in 2013 culminated in 22,170 cases. In the absence of a vaccine on the market, vector control is the key approach for prevention. OBJECTIVES We sought to forecast the evolution of dengue epidemics in Singapore to provide early warning of outbreaks and to facilitate the public health response to moderate an impending outbreak. METHODS We developed a set of statistical models using least absolute shrinkage and selection operator (LASSO) methods to forecast the weekly incidence of dengue notifications over a 3-month time horizon. This forecasting tool used a variety of data streams and was updated weekly, including recent case data, meteorological data, vector surveillance data, and population-based national statistics. The forecasting methodology was compared with alternative approaches that have been proposed to model dengue case data (seasonal autoregressive integrated moving average and step-down linear regression) by fielding them on the 2013 dengue epidemic, the largest on record in Singapore. RESULTS Operationally useful forecasts were obtained at a 3-month lag using the LASSO-derived models. Based on the mean average percentage error, the LASSO approach provided more accurate forecasts than the other methods we assessed. We demonstrate its utility in Singapore's dengue control program by providing a forecast of the 2013 outbreak for advance preparation of outbreak response. CONCLUSIONS Statistical models built using machine learning methods such as LASSO have the potential to markedly improve forecasting techniques for recurrent infectious disease outbreaks such as dengue. CITATION Shi Y, Liu X, Kok SY, Rajarethinam J, Liang S, Yap G, Chong CS, Lee KS, Tan SS, Chin CK, Lo A, Kong W, Ng LC, Cook AR. 2016. Three-month real-time dengue forecast models: an early warning system for outbreak alerts and policy decision support in Singapore. Environ Health Perspect 124:1369-1375; http://dx.doi.org/10.1289/ehp.1509981.
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Affiliation(s)
| | - Xu Liu
- Environmental Health Institute,
| | | | | | | | | | | | | | | | | | - Andrew Lo
- Centre for Climate Research Singapore, National Environment Agency, Singapore
| | - Waiming Kong
- School of Engineering, Nanyang Polytechnic, Singapore
| | - Lee Ching Ng
- Environmental Health Institute,
- School of Biological Sciences, Nanyang Technological University, Singapore
| | - Alex R. Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yale-NUS College, National University of Singapore, Singapore
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de Oliveira LH, Trumbo SP, Ruiz Matus C, Sanwogou NJ, Toscano CM. Pneumococcal conjugate vaccine introduction in Latin America and the Caribbean: progress and lessons learned. Expert Rev Vaccines 2016; 15:1295-304. [PMID: 26982434 DOI: 10.1586/14760584.2016.1166961] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In Latin America and the Caribbean, pneumococcus has been estimated to cause 12,000-28,000 deaths, 182,000 hospitalizations, and 1.4 million clinic visits annually. Countries in the Americas have been among the first developing nations to introduce pneumococcal conjugate vaccines into their Expanded Programs on Immunization, with 34 countries and territories having introduced these vaccines as of September 2015. Lessons learned for successful vaccine introduction include the importance of coordination between political and technical decision makers, adjustments to the cold chain prior to vaccine introduction, and the need for detailed plans addressing the financial and technical sustainability of introduction. Though many questions on the Pneumococcal Conjugate Vaccine remain unanswered, the experience of the Americas suggests that the vaccines can be introduced quickly and effectively.
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Affiliation(s)
- Lucia Helena de Oliveira
- a Comprehensive Family Immunization Unit , Pan American Health Organization , Washington , DC , USA
| | | | - Cuauhtémoc Ruiz Matus
- a Comprehensive Family Immunization Unit , Pan American Health Organization , Washington , DC , USA
| | - N Jennifer Sanwogou
- a Comprehensive Family Immunization Unit , Pan American Health Organization , Washington , DC , USA
| | - Cristiana M Toscano
- c Department of Community Health, Institute of Tropical Pathology and Public Health , Federal University of Goiás , Goiânia , Brazil
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Lim JK, Lee YS, Wilder-Smith A, Thiry G, Mahoney R, Yoon IK. Points for Consideration for dengue vaccine introduction – recommendations by the Dengue Vaccine Initiative. Expert Rev Vaccines 2016; 15:529-38. [DOI: 10.1586/14760584.2016.1129279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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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.
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Affiliation(s)
- Yesim Tozan
- a College of Global Public Health , New York University , New York , NY , USA
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11
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McArthur MA, Edelman R. A Promising, Single-Dose, Live Attenuated Tetravalent Dengue Vaccine Candidate. J Infect Dis 2015; 212:681-3. [PMID: 25801651 DOI: 10.1093/infdis/jiv086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Monica A McArthur
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
| | - Robert Edelman
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
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Undurraga EA, Betancourt-Cravioto M, Ramos-Castañeda J, Martínez-Vega R, Méndez-Galván J, Gubler DJ, Guzmán MG, Halstead SB, Harris E, Kuri-Morales P, Tapia-Conyer R, Shepard DS. Economic and disease burden of dengue in Mexico. PLoS Negl Trop Dis 2015; 9:e0003547. [PMID: 25786225 PMCID: PMC4364886 DOI: 10.1371/journal.pntd.0003547] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/17/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dengue imposes a substantial economic and disease burden in most tropical and subtropical countries. Dengue incidence and severity have dramatically increased in Mexico during the past decades. Having objective and comparable estimates of the economic burden of dengue is essential to inform health policy, increase disease awareness, and assess the impact of dengue prevention and control technologies. METHODS AND FINDINGS We estimated the annual economic and disease burden of dengue in Mexico for the years 2010-2011. We merged multiple data sources, including a prospective cohort study; patient interviews and macro-costing from major hospitals; surveillance, budget, and health data from the Ministry of Health; WHO cost estimates; and available literature. We conducted a probabilistic sensitivity analysis using Monte Carlo simulations to derive 95% certainty levels (CL) for our estimates. Results suggest that Mexico had about 139,000 (95%CL: 128,000-253,000) symptomatic and 119 (95%CL: 75-171) fatal dengue episodes annually on average (2010-2011), compared to an average of 30,941 symptomatic and 59 fatal dengue episodes reported. The annual cost, including surveillance and vector control, was US$170 (95%CL: 151-292) million, or $1.56 (95%CL: 1.38-2.68) per capita, comparable to other countries in the region. Of this, $87 (95%CL: 87-209) million or $0.80 per capita (95%CL: 0.62-1.12) corresponds to illness. Annual disease burden averaged 65 (95%CL: 36-99) disability-adjusted life years (DALYs) per million population. Inclusion of long-term sequelae, co-morbidities, impact on tourism, and health system disruption during outbreaks would further increase estimated economic and disease burden. CONCLUSION With this study, Mexico joins Panama, Puerto Rico, Nicaragua, and Thailand as the only countries or areas worldwide with comprehensive (illness and preventive) empirical estimates of dengue burden. Burden varies annually; during an outbreak, dengue burden may be significantly higher than that of the pre-vaccine level of rotavirus diarrhea. In sum, Mexico's potential economic benefits from dengue control would be substantial.
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Affiliation(s)
- Eduardo A. Undurraga
- Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, United States of America
| | | | - José Ramos-Castañeda
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Center for Tropical Diseases, University of Texas-Medical Branch, Galveston, Texas, United States of America
| | - Ruth Martínez-Vega
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Organización Latinoamericana para el Fomento de la Investigación en Salud, Bucaramanga, Colombia
| | | | | | | | - Scott B. Halstead
- Pediatric Dengue Vaccine Initiative, Rockville, Maryland, United States of America
| | - Eva Harris
- University of California, Berkeley, Berkeley, California, United States of America
| | | | | | - Donald S. Shepard
- Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts, United States of America
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Ghosh A, Dar L. Dengue vaccines: Challenges, development, current status and prospects. Indian J Med Microbiol 2015; 33:3-15. [DOI: 10.4103/0255-0857.148369] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ramakrishnan L, Pillai MR, Nair RR. Dengue vaccine development: strategies and challenges. Viral Immunol 2014; 28:76-84. [PMID: 25494228 DOI: 10.1089/vim.2014.0093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Infection with dengue virus may result in dengue fever or a more severe outcome, such as dengue hemorrhagic syndrome/shock. Dengue virus infection poses a threat to endemic regions for four reasons: the presence of four serotypes, each with the ability to cause a similar disease outcome, including fatality; difficulties related to vector control; the lack of specific treatment; and the nonavailability of a suitable vaccine. Vaccine development is considered challenging due to the severity of the disease observed in individuals who have acquired dengue-specific immunity, either passively or actively. Therefore, the presence of vaccine-induced immunity against a particular serotype may prime an individual to severe disease on exposure to dengue virus. Vaccine development strategies include live attenuated vaccines, chimeric, DNA-based, subunit, and inactivated vaccines. Each of the candidates is in various stages of preclinical and clinical development. Issues pertaining to selection pressures, viral interaction, and safety still need to be evaluated in order to induce a complete protective immune response against all four serotypes. This review highlights the various strategies that have been employed in vaccine development, and identifies the obstacles to producing a safe and effective vaccine.
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Affiliation(s)
- Lakshmy Ramakrishnan
- 1 Laboratory Medicine and Molecular Diagnostics, Rajiv Gandhi Centre for Biotechnology , Trivandrum, India
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15
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Affiliation(s)
- Ann M Powers
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80521, USA.
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Amaya-Larios IY, Martínez-Vega RA, Mayer SV, Galeana-Hernández M, Comas-García A, Sepúlveda-Salinas KJ, Falcón-Lezama JA, Vasilakis N, Ramos-Castañeda J. Seroprevalence of neutralizing antibodies against dengue virus in two localities in the state of Morelos, Mexico. Am J Trop Med Hyg 2014; 91:1057-65. [PMID: 25294613 DOI: 10.4269/ajtmh.14-0145] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Humoral immune response against dengue virus (DENV) is an important component in dengue-endemic transmission. We conducted a cross-sectional nested cohort study to determine the seroprevalence and frequency of neutralizing antibodies against DENV serotypes in two endemic localities in the state of Morelos, Mexico. The cohort participants (N = 1,196) were screened to determine previous exposure to DENV. Overall seroprevalence was 76.6% (95% confidence interval [95% CI] = 73.6-79.2), and prevalence of neutralizing antibodies in the 5- to 9-year-old group was 82.5% (95% CI = 67.2-92.7), 45% (95% CI = 29.3-61.5), and 65% (95% CI = 48.3-79.4) for DENV-1, DENV-2, and DENV-3, respectively. For participants older than 10 years, the observed seroprevalence was above 60% for each serotype, except DENV-4 in the 10- to 25-year-old group (42.9%); 81% of humoral responses were multitypic. The outcomes of our study contribute to understanding the immune component of dengue transmission and provide focal information for the evaluation of vaccine candidates under development.
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Affiliation(s)
- Irma Y Amaya-Larios
- Centro de Investigaci?n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico; Organizacion Latinoamericana para el Fomento de la Investigacion en Salud, Bucaramanga, Stder, Colombia; Department of Pathology and Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas; Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas
| | - Ruth Aralí Martínez-Vega
- Centro de Investigaci?n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico; Organizacion Latinoamericana para el Fomento de la Investigacion en Salud, Bucaramanga, Stder, Colombia; Department of Pathology and Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas; Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas
| | - Sandra V Mayer
- Centro de Investigaci?n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico; Organizacion Latinoamericana para el Fomento de la Investigacion en Salud, Bucaramanga, Stder, Colombia; Department of Pathology and Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas; Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas
| | - Marisol Galeana-Hernández
- Centro de Investigaci?n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico; Organizacion Latinoamericana para el Fomento de la Investigacion en Salud, Bucaramanga, Stder, Colombia; Department of Pathology and Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas; Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas
| | - Andreu Comas-García
- Centro de Investigaci?n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico; Organizacion Latinoamericana para el Fomento de la Investigacion en Salud, Bucaramanga, Stder, Colombia; Department of Pathology and Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas; Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas
| | - Karla J Sepúlveda-Salinas
- Centro de Investigaci?n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico; Organizacion Latinoamericana para el Fomento de la Investigacion en Salud, Bucaramanga, Stder, Colombia; Department of Pathology and Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas; Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas
| | - Jorge A Falcón-Lezama
- Centro de Investigaci?n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico; Organizacion Latinoamericana para el Fomento de la Investigacion en Salud, Bucaramanga, Stder, Colombia; Department of Pathology and Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas; Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas
| | - Nikos Vasilakis
- Centro de Investigaci?n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico; Organizacion Latinoamericana para el Fomento de la Investigacion en Salud, Bucaramanga, Stder, Colombia; Department of Pathology and Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas; Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas
| | - José Ramos-Castañeda
- Centro de Investigaci?n Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico; Organizacion Latinoamericana para el Fomento de la Investigacion en Salud, Bucaramanga, Stder, Colombia; Department of Pathology and Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas; Institute of Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas
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17
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Chiang CY, Hsieh CH, Chen MY, Tsai JP, Liu HH, Liu SJ, Chong P, Leng CH, Chen HW. Recombinant lipidated dengue-4 envelope protein domain III elicits protective immunity. Vaccine 2014; 32:1346-53. [PMID: 24486311 DOI: 10.1016/j.vaccine.2014.01.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/06/2014] [Accepted: 01/15/2014] [Indexed: 02/06/2023]
Abstract
The combination of recombinant protein antigens with an immunostimulator has the potential to greatly increase the immunogenicity of recombinant protein antigens. In the present study, we selected the dengue-4 envelope protein domain III as a dengue vaccine candidate and expressed the protein in lipidated form using an Escherichia coli-based system. The recombinant lipidated dengue-4 envelope protein domain III folded into the proper conformation and competed with the dengue-4 virus for cellular binding sites. Mice immunized with lipidated dengue-4 envelope protein domain III without exogenous adjuvant had higher frequencies of dengue-4 envelope protein domain III-specific B cells secreting antibodies than mice immunized with the nonlipidated form. Importantly, lipidated dengue-4 envelope protein domain III-immunized mice demonstrated a durable neutralizing antibody response and had reduced viremia levels after challenge. The study demonstrates that lipidated dengue-4 envelope protein domain III is immunogenic and may be a potential dengue vaccine candidate. Furthermore, the lipidation strategy can be applied to other serotypes of dengue virus.
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Affiliation(s)
- Chen-Yi Chiang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan 350, Miaoli, Taiwan, ROC
| | - Chun-Hsiang Hsieh
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan 350, Miaoli, Taiwan, ROC
| | - Mei-Yu Chen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan 350, Miaoli, Taiwan, ROC
| | - Jy-Ping Tsai
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan 350, Miaoli, Taiwan, ROC
| | - Hsueh-Hung Liu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan 350, Miaoli, Taiwan, ROC
| | - Shih-Jen Liu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan 350, Miaoli, Taiwan, ROC; Graduate Institute of Immunology, China Medical University, Taichung, Taiwan, ROC
| | - Pele Chong
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan 350, Miaoli, Taiwan, ROC; Graduate Institute of Immunology, China Medical University, Taichung, Taiwan, ROC
| | - Chih-Hsiang Leng
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan 350, Miaoli, Taiwan, ROC; Graduate Institute of Immunology, China Medical University, Taichung, Taiwan, ROC.
| | - Hsin-Wei Chen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, 35 Keyan Road, Zhunan 350, Miaoli, Taiwan, ROC; Graduate Institute of Immunology, China Medical University, Taichung, Taiwan, ROC.
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18
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Kochhar S, Rath B, Seeber LD, Rundblad G, Khamesipour A, Ali M. Introducing new vaccines in developing countries. Expert Rev Vaccines 2014; 12:1465-78. [DOI: 10.1586/14760584.2013.855612] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Chao DL, Longini IM, Halloran ME. The effects of vector movement and distribution in a mathematical model of dengue transmission. PLoS One 2013; 8:e76044. [PMID: 24204590 PMCID: PMC3804532 DOI: 10.1371/journal.pone.0076044] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/21/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mathematical models have been used to study the dynamics of infectious disease outbreaks and predict the effectiveness of potential mass vaccination campaigns. However, models depend on simplifying assumptions to be tractable, and the consequences of making such assumptions need to be studied. Two assumptions usually incorporated by mathematical models of vector-borne disease transmission is homogeneous mixing among the hosts and vectors and homogeneous distribution of the vectors. METHODOLOGY/PRINCIPAL FINDINGS We explored the effects of mosquito movement and distribution in an individual-based model of dengue transmission in which humans and mosquitoes are explicitly represented in a spatial environment. We found that the limited flight range of the vector in the model greatly reduced its ability to transmit dengue among humans. A model that does not assume a limited flight range could yield similar attack rates when transmissibility of dengue was reduced by 39%. A model in which mosquitoes are distributed uniformly across locations behaves similarly to one in which the number of mosquitoes per location is drawn from an exponential distribution with a slightly higher mean number of mosquitoes per location. When the models with different assumptions were calibrated to have similar human infection attack rates, mass vaccination had nearly identical effects. CONCLUSIONS/SIGNIFICANCE Small changes in assumptions in a mathematical model of dengue transmission can greatly change its behavior, but estimates of the effectiveness of mass dengue vaccination are robust to some simplifying assumptions typically made in mathematical models of vector-borne disease.
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Affiliation(s)
- Dennis L. Chao
- Center for Statistics and Quantitative Infectious Diseases, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- * E-mail:
| | - Ira M. Longini
- Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - M. Elizabeth Halloran
- Center for Statistics and Quantitative Infectious Diseases, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, United States of America
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