Challenges in Reducing Dengue Burden

Abstract and Introduction

Abstract

Dengue is a major public health concern worldwide, with the number of infections increasing globally. The illness imposes the greatest economic and human burden on developing countries that have limited resources to deal with the scale of the problem. No cure for dengue exists; treatment is limited to rehydration therapy, and with vector control strategies proving to be relatively ineffective, a vaccine is an urgent priority. Despite the numerous challenges encountered in the development of a dengue vaccine, several vaccine candidates have shown promise in clinical development and it is believed that a vaccination program would be at least as cost-effective as current vector control programs. The lead candidate vaccine is a tetravalent, live attenuated, recombinant vaccine, which is currently in Phase III clinical trials. Vaccine introduction is a complex process that requires consideration and is discussed here. This review discusses the epidemiology, burden and pathogenesis of dengue, as well as the vaccine candidates currently in clinical development.

Introduction

Dengue is a major public health concern, with approximately 40% of the world's population at risk of the illness.^[201] The severe forms of the disease – dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) – result in significant morbidity and mortality.^[202] In recent decades, the disease has spread from endemic areas within tropical and subtropical regions of the globe, to traditionally dengue-free regions where social and environmental conditions for dengue exist, making endemicity a tangible threat.^[1]

Dengue imposes significant economic and human costs, particularly in developing countries, which shoulder the greatest burden of the illness.^[2,3,4,203] However, with no anti-viral drugs currently available, treatment is limited to intravenous rehydration therapy.^[5] Vector control is currently the only means of checking dengue transmission, but it faces several challenges, such as insecticide resistance, toxicity concerns and biosafety issues, community acceptance of certain measures and sustainability.^[5]

There is, therefore, an urgent unmet need for a safe and effective vaccine against dengue. Despite significant challenges in the development of vaccines, there are several candidates in clinical development that provide promising options to combat this devastating disease.^[6] This review discusses the global impact of dengue and the importance of developing a vaccine targeted against the disease, while also providing an overview of dengue vaccines currently in development.