Abstract
The first approved dengue vaccine, CYD-TDV, a chimeric, live-attenuated, tetravalent dengue virus vaccine, was recently licensed in 13 countries, including Brazil. In light of recent vaccine approval, we modeled the cost-effectiveness of potential vaccination policies mathematically based on data from recent vaccine efficacy trials that indicated that vaccine efficacy was lower in seronegative individuals than in seropositive individuals. In our analysis, we investigated several vaccination programs, including routine vaccination, with various vaccine coverage levels and those with and without large catch-up campaigns. As it is unclear whether the vaccine protects against infection or just against disease, our model incorporated both direct and indirect effects of vaccination. We found that in the presence of vaccine-induced indirect protection, the cost-effectiveness of dengue vaccination decreased with increasing vaccine coverage levels because the marginal returns of herd immunity decreases with vaccine coverage. All routine dengue vaccination programs that we considered were cost-effective, reducing dengue incidence significantly. Specifically, a routine dengue vaccination of 9-year-olds would be cost-effective when the cost of vaccination per individual is less than $262. Furthermore, the combination of routine vaccination and large catch-up campaigns resulted in a greater reduction of dengue burden (by up to 93%) than routine vaccination alone, making it a cost-effective intervention as long as the cost per course of vaccination is $255 or less. Our results show that dengue vaccination would be cost-effective in Brazil even with a relatively low vaccine efficacy in seronegative individuals.
Highlights
Dengue is a febrile illness caused by any one of the four serotypes of dengue virus (DENV-1, DENV-2, DENV-3, or DENV-4).[1]
This means that the number of dengue cases prevented over a 10-year period compared with the situation without vaccination would range from 14,800,000 with routine vaccination of 9-year-olds (50% vaccine coverage) to 19,979,900 with a catch-up campaign of 9- to 45-year-olds followed by routine vaccination of 9-year-olds (70% vaccine coverage level)
The number of dengue hemorrhagic fever (DHF) cases prevented over a 10-year period with a vaccination program is estimated to range from 394,024 with routine vaccination of 9-year-olds (50% vaccine coverage level) to 535,660 with a catch-up campaign for 9- to 45-year-olds followed by routine vaccination of 9-year-olds (70% vaccine coverage)
Summary
Dengue is a febrile illness caused by any one of the four serotypes of dengue virus (DENV-1, DENV-2, DENV-3, or DENV-4).[1] The disease is transmitted from human to human through the bite of mosquitoes of the genus Aedes.[2] Dengue is endemic in more than 100 countries, and nearly 4 billion people are at risk for dengue, with 390 million dengue infections occurring every year.[3]. The outcomes of dengue infection range from asymptomatic and subclinical to symptomatic infections.[4] Symptomatic infections vary from a mild, flu-like illness known as dengue fever (DF) to severe dengue, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS).[2] Infection with dengue virus provides long-term protection against the particular serotype that caused the disease. Individuals experiencing their second natural dengue infection have a higher risk of severe disease than those experiencing primary infections, an effect referred to as antibody-dependent enhancement (ADE).[6]
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