Dengue Vaccine Development and Deployment into Routine Immunization

Abstract

Dengue has emerged as a significant global health threat. Despite decades of research, only two dengue vaccines-CYD-TDV (Dengvaxia) and TAK-003 (Qdenga)-have been licensed to date, with limited implementation. This paper explores and outlines strategies for integrating dengue vaccines into routine immunization programs, particularly in high-burden regions. TAK-003, a tetravalent live-attenuated vaccine, has demonstrated 61% efficacy against virologically confirmed dengue and 84% efficacy against hospitalizations in endemic settings. However, concerns remain about vaccine-enhanced disease, particularly among seronegative individuals exposed to DENV3 and DENV4. WHO recommends targeted introduction in high-transmission settings without pre-vaccination screening, while ongoing post-introduction studies will further clarify long-term safety and efficacy. Effective vaccine rollout requires a multi-pronged approach, including school-based immunization, integration with adolescent health services, and strong community engagement. Decision-making for vaccine introduction should be guided by National Immunization Technical Advisory Groups (NITAGs), local epidemiological data, and cost-effectiveness assessments. While future vaccines, including mRNA and virus-like particle candidates, are under development, optimizing the use of currently available vaccines is crucial to reducing dengue's public health impact. Given the continued rise in cases, immediate action-combining vaccination with vector control-is essential to prevent further morbidity and mortality.

Keywords: CYD-TDV; Qdenga; TAK-003; Wolbachia; antibody-dependent enhancement; dengue; mRNA vaccines; school-based programs.