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

• Published in: Expert review of vaccines Vol. 17; no. 8; pp. 753 - 763
• Main Authors: Coudeville, Laurent, Baurin, Nicolas, Olivera-Botello, Gustavo
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Group 03.08.2018
• Subjects: Adolescent; benefit-risk; Child; Child, Preschool; Clinical Trials as Topic; Cohort Studies; Dengue - epidemiology; Dengue - prevention & control; Dengue - transmission; dengue fever; Dengue Vaccines - administration & dosage; Dengue Vaccines - immunology; disease transmission; Hospitalization - statistics & numerical data; Humans; modeling; Models, Theoretical; Public Health; Seroepidemiologic Studies; Severe Dengue - epidemiology; Severe Dengue - prevention & control; Severe Dengue - transmission; Time Factors; Vaccination; Benefit-risk; dengue fever; modeling; disease transmission; vaccination
• ISSN: 1476-0584; 1744-8395
• DOI: 10.1080/14760584.2018.1503955

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. 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. Symptomatic dengue cases, dengue hospitalizations, and severe dengue cases. 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. 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.