Immunization, Vaccines and Biologicals

Dengue

Dengue is a mosquito-borne flavivirus found in tropical and sub-tropical regions of the world, mostly in urban and semi-urban settings. Day-biting Aedes mosquitos spread disease. It is the fastest spreading vector-borne viral disease and is now endemic in over 100 countries, resulting in 40% of the world’s population living in an area at risk for dengue. It is caused by one of four distinct serotypes (dengue 1-4). While the first infection with one of the four dengue serotypes is typically non-severe or asymptomatic, individuals who are subsequently exposed in later years to one of the other serotypes are more likely to develop severe dengue. Non-severe dengue illness often presents as flu-like illness, with symptoms included high fever, severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands, or rash. Severe dengue, including dengue hemorrhagic fever or dengue shock syndrome, is characterized by severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness, and blood in vomit, and may be fatal due to plasma leakage, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Although there is no specific treatment for dengue, case fatality rates can be below 1% with proper case management. In its absence, the case fatality rate can be has high at 20% in patients with severe dengue.

The first dengue vaccine, Dengvaxia (CYD-TDV) by Sanofi Pasteur, was first licensed in December, 2015, in Mexico. It has been registered for use in individuals 9-45 years of age living in endemic areas. CYD-TDV is a live recombinant tetravalent vaccine based on the yellow fever 17d backbone and is registered as a 3-dose vaccine given on a 0/6/12 month schedule. Several other vaccine candidates are in clinical or pre-clinical development.

Registration of a vaccine is a separate process to public health recommendations for use of a vaccine. There are currently no WHO recommendations for use of a dengue vaccine. The WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed CYD-TDV in April 2016 and recommended countries consider introduction of the vaccine only in geographic settings (national or subnational) with high endemicity. A WHO vaccine position paper will be published outlining WHO recommendations in July 2016.

WHO recommends prevention of dengue through vector control methods such as mosquito habitat removal and use of insecticides. Integrated vector control, surveillance, case management, and future vaccines are the technical elements of WHO’s dengue control strategy.

The development of a safe and effective dengue vaccine is a high priority and WHO supports this effort through technical guidance and advice.

WHO position papers

There is currently no WHO position paper for dengue. WHO and SAGE are in the process of reviewing the evidence for the licensed dengue vaccine that will be the basis of a future position paper. Following the recommendations made by SAGE in April 2016, a WHO vaccine position paper will be published outlining WHO recommendations in July 2016.

Prequalified vaccines

There are no WHO pre-qualified vaccines against dengue.

Disease burden/surveillance

Further information

Resources

Links to other WHO dengue pages

Related partner links

Last updated: 15 April 2016