Expert Review of Vaccines (Aug 2018)

Assessment of benefits and risks associated with dengue vaccination at the individual and population levels: a dynamic modeling approach

  • Laurent Coudeville,
  • Nicolas Baurin,
  • Gustavo Olivera-Botello

DOI
https://doi.org/10.1080/14760584.2018.1503955
Journal volume & issue
Vol. 17, no. 8
pp. 753 – 763

Abstract

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Background: A case-cohort study, using a novel assay and data from three dengue vaccine efficacy trials, highlighted differences in vaccination outcomes according to baseline serostatus. Based on these results, we explored, with a model, the benefits and risks associated with vaccination. Research design and methods: Parameters of a previously developed transmission model were estimated with subject-level data from a case-cohort study. The model was used to assess vaccination outcomes for a range of transmission settings over 5–30 years, with or without indirect protection. Main outcome measures: Symptomatic dengue cases, dengue hospitalizations, and severe dengue cases. Results: The model is consistent with previous results indicating a transitory period at increased risk for dengue-seronegative vaccine recipients (setting-dependent duration) and long-term benefits for dengue-seropositive recipients. At the population level, benefits to seropositive individuals over 10 years outweighed the risk to those seronegative in moderate to high transmission settings (≥50% seropositivity at age 9), especially in high transmission settings (no excess hospitalizations in dengue-seronegative for ≥80% seropositivity at age 9). Results were more favorable when longer time horizons or indirect protection were considered. Conclusions: Results indicate a public health benefit associated with dengue vaccination especially in high-transmission settings, even with the initial excess risks to dengue-seronegative patients which diminish over time.

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