title: Benefits and risks of the Sanofi-Pasteur dengue vaccine: Modeling optimal deployment.
abstract: The first approved dengue vaccine has now been licensed in six countries. We propose that this live attenuated vaccine acts like a silent natural infection in priming or boosting host immunity. A transmission dynamic model incorporating this hypothesis fits recent clinical trial data well and predicts that vaccine effectiveness depends strongly on the age group vaccinated and local transmission intensity. Vaccination in low-transmission settings may increase the incidence of more severe "secondary-like" infection and, thus, the numbers hospitalized for dengue. In moderate transmission settings, we predict positive impacts overall but increased risks of hospitalization with dengue disease for individuals who are vaccinated when seronegative. However, in high-transmission settings, vaccination benefits both the whole population and seronegative recipients. Our analysis can help inform policy-makers evaluating this and other candidate dengue vaccines.
authors.affiliation: MRC Centre for Outbreak Analysis and Modelling, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK. neil.ferguson@imperial.ac.uk.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Ferguson
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Rodríguez-Barraquer
authors.affiliation: MRC Centre for Outbreak Analysis and Modelling, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Dorigatti
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Mier-Y-Teran-Romero
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Laydon
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. Department of Biology and Emerging Pathogens Institute, University of Florida, Post Office Box 100009, Gainesville, FL 32610, USA.
authors.forename: Derek A T
authors.initials: DA
authors.lastname: Cummings
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003715:Dengue / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D053059:Dengue Vaccines / Q000008:administration & dosage / Q000276:immunology*; D003716:Dengue Virus; D006760:Hospitalization; D006801:Humans; D000071497:Immunogenicity, Vaccine; D008962:Models, Theoretical; D018570:Risk Assessment; D014611:Vaccination; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology
chemical_list: D053059:Dengue Vaccines; D014613:Vaccines, Attenuated