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Abstract
Live-attenuated vaccines replicate at low concentrations and elicit protective immunity without causing disease. This strategy has proven to be successful when the vaccine targets one pathogen, as is the case for vaccines against yellow fever and Japanese encephalitis viruses. 1 Gubler DJ Kuno G Markoff L Flaviviruses. in: Knipe DM Howley PM Fields Virology. 5th edn. Wolters Kluwer and Lippincott Williams & Wilkins, Philadelphia2007: 1153-1252 Google Scholar Translation of this straightforward idea to target dengue has proven frustrating, because dengue is a complex flaviviral disease that is caused by not one, but four antigenically distinct dengue viruses (DENV-1, 2, 3, and 4). Extension of the live-attenuated vaccine approach to dengue by mixing four monovalent attenuated dengue vaccine viruses into a tetravalent formulation was assessed by investigators at Mahidol University, Thailand, in a tetravalent dengue live-attenuated vaccine trial. 2 Kanesa-thasan N Sun W Kim-Ahn G et al. Safety and immunogenicity of attenuated dengue virus vaccines (Aventis Pasteur) in human volunteers. Vaccine. 2001; 19: 3179-3188 Crossref PubMed Scopus (192) Google Scholar With this approach, viral interference was reported, in which antibody responses to particular dengue serotypes were reduced or obliterated.
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