title: Potential opportunities and perils of imperfect dengue vaccines.
abstract: Dengue vaccine development efforts have focused on the development of tetravalent vaccines. However, a recent Phase IIb trial of a tetravalent vaccine indicates a protective effect against only 3 of the 4 serotypes. While vaccines effective against a subset of serotypes may reduce morbidity and mortality, particular profiles could result in an increased number of cases due to immune enhancement and other peculiarities of dengue epidemiology. Here, we use a compartmental transmission model to assess the impact of partially effective vaccines in a hyperendemic Thai population. Crucially, we evaluate the effects that certain serotype heterogeneities may have in the presence of mass-vaccination campaigns. In the majority of scenarios explored, partially effective vaccines lead to 50% or greater reductions in the number of cases. This is true even of vaccines that we would not expect to proceed to licensure due to poor or incomplete immune responses. Our results show that a partially effective vaccine can have significant impacts on serotype distribution and mean age of cases.
authors.affiliation: Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Rodriguez-Barraquer
authors.affiliation: Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA; Nonlinear Systems Dynamics Section, Plasma Physics Division, U.S. Naval Research Laboratory, Washington, DC 20375, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Mier-y-Teran-Romero
authors.affiliation: Nonlinear Systems Dynamics Section, Plasma Physics Division, U.S. Naval Research Laboratory, Washington, DC 20375, USA.
authors.forename: Ira B
authors.initials: IB
authors.lastname: Schwartz
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Burke
authors.affiliation: Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA. Electronic address: dcumming@jhsph.edu.
authors.forename: Derek A T
authors.initials: DA
authors.lastname: Cummings
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D003715:Dengue / Q000517:prevention & control* / Q000635:transmission; D053059:Dengue Vaccines / Q000627:therapeutic use*; D003716:Dengue Virus / Q000145:classification; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D008962:Models, Theoretical; D013785:Thailand; D055815:Young Adult
chemical_list: D053059:Dengue Vaccines
keywords: Dengue vaccine; Mathematical model; Vaccine effects