Vaccination against dengue fever for travellers: Statement of the Swiss Expert Committee for Travel Medicine, an organ of the Swiss Society for Tropical and Travel Medicine, August 2024
Dengue fever, endemic to most tropical and subtropical countries, is a major cause of illness in travellers, but severe dengue, hospitalisation and death are considered rare in this population. Two vaccines against dengue fever, Dengvaxia® and Qdenga®, are available. While there is no recommendation for the use of Dengvaxia® in travellers, Qdenga® has been licensed for travellers in many European countries since December 2022, most recently (29 July 2024) in Switzerland by Swissmedic.
The Swiss Expert Committee for Travel Medicine (ECTM), having assessed available data on the Qdenga® vaccine, issues the following recommendations:
(1) Vaccination against dengue fever virus with Qdenga® is not recommended for persons with no previous dengue fever infection.
(2) Vaccination with Qdenga® may be recommended for travellers aged 6 years and older who have evidence of previous dengue infection, defined as (a) a laboratory-confirmed dengue infection (PCR, antigen or seroconversion) or (b) a compatible history of dengue infection with a positive IgG serological test AND expected exposure to a region with significant dengue transmission.
Travel medicine advisors should provide clear information in accessible language on the complexity of dengue vaccines and the risk/benefit evaluation for their use in travellers.
Yang X, Quam MB, Zhang T, Sang S. Global burden for dengue and the evolving pattern in the past 30 years. J Travel Med. 2021 Dec;28(8):taab146. doi: https://doi.org/10.1093/jtm/taab146
Halstead S, Wilder-Smith A. Severe dengue in travellers: pathogenesis, risk and clinical management. J Travel Med. 2019 Oct;26(7):taz062. doi: https://doi.org/10.1093/jtm/taz062
Huits R, Angelo KM, Amatya B, Barkati S, Barnett ED, Bottieau E, et al. Clinical Characteristics and Outcomes Among Travelers With Severe Dengue: A GeoSentinel Analysis. Ann Intern Med. 2023 Jul;176(7):940–8. doi: https://doi.org/10.7326/M23-0721
Duvignaud A, Stoney RJ, Angelo D O KM, Chen LH, Cattaneo P, Motta L, et al.; GeoSentinel Network. Epidemiology of Travel-Associated Dengue from 2007 to 2022: A GeoSentinel Analysis. J Travel Med. 2024 Jul;2:taae089. doi: https://doi.org/10.1093/jtm/taae089
Guo C, Zhou Z, Wen Z, Liu Y, Zeng C, Xiao D, et al. Global Epidemiology of Dengue Outbreaks in 1990-2015: A Systematic Review and Meta-Analysis. Front Cell Infect Microbiol. 2017 Jul;7:317. doi: https://doi.org/10.3389/fcimb.2017.00317
Halstead SB, Dans LF. Dengue infection and advances in dengue vaccines for children. Lancet Child Adolesc Health. 2019 Oct;3(10):734–41. doi: https://doi.org/10.1016/S2352-4642(19)30205-6
Katzelnick LC, Gresh L, Halloran ME, Mercado JC, Kuan G, Gordon A, et al. Antibody-dependent enhancement of severe dengue disease in humans. Science. 2017 Nov;358(6365):929–32. doi: https://doi.org/10.1126/science.aan6836
Huits R, Angelo KM, Amatya B, Barkati S, Barnett ED, Bottieau E, et al. Clinical Characteristics and Outcomes Among Travelers With Severe Dengue: A GeoSentinel Analysis. Ann Intern Med. 2023 Jul;176(7):940–8. doi: https://doi.org/10.7326/M23-0721
WHO Technical Report Series No 932. Guidelines on the quality, safety and efficacy of dengue tetravalent vaccines (live, attenuated). 2011.
Capeding MR, Tran NH, Hadinegoro SR, Ismail HI, Chotpitayasunondh T, Chua MN, et al.; CYD14 Study Group. Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial. Lancet. 2014 Oct;384(9951):1358–65. doi: https://doi.org/10.1016/S0140-6736(14)61060-6
Villar L, Dayan GH, Arredondo-García JL, Rivera DM, Cunha R, Deseda C, et al.; CYD15 Study Group. Efficacy of a tetravalent dengue vaccine in children in Latin America. N Engl J Med. 2015 Jan;372(2):113–23. doi: https://doi.org/10.1056/NEJMoa1411037
Sridhar S, Luedtke A, Langevin E, Zhu M, Bonaparte M, Machabert T, et al. Effect of Dengue Serostatus on Dengue Vaccine Safety and Efficacy. N Engl J Med. 2018 Jul;379(4):327–40. doi: https://doi.org/10.1056/NEJMoa1800820
de Silva A, White L. Immunogenicity of a Live Dengue Vaccine (TAK-003). J Infect Dis. 2022 Dec;227(1):163–4. doi: https://doi.org/10.1093/infdis/jiac424
Tian Y, Grifoni A, Sette A, Weiskopf D, Human T. Human T Cell Response to Dengue Virus Infection. Front Immunol. 2019 Sep;10:2125. doi: https://doi.org/10.3389/fimmu.2019.02125
Biswal S, Reynales H, Saez-Llorens X, Lopez P, Borja-Tabora C, Kosalaraksa P, et al.; TIDES Study Group. Efficacy of a Tetravalent Dengue Vaccine in Healthy Children and Adolescents. N Engl J Med. 2019 Nov;381(21):2009–19. doi: https://doi.org/10.1056/NEJMoa1903869
Tricou V, Yu D, Reynales H, Biswal S, Saez-Llorens X, Sirivichayakul C, et al. Long-term efficacy and safety of a tetravalent dengue vaccine (TAK-003): 4·5-year results from a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Glob Health. 2024 Feb;12(2):e257–70. doi: https://doi.org/10.1016/S2214-109X(23)00522-3
Rivera L, Biswal S, Sáez-Llorens X, Reynales H, López-Medina E, Borja-Tabora C, et al. Three-year Efficacy and Safety of Takeda’s Dengue Vaccine Candidate (TAK-003). Clin Infect Dis. 2022 Aug;75(1):107–17. doi: https://doi.org/10.1093/cid/ciab864
Chan KR, Ismail AA, Thergarajan G, Raju CS, Yam HC, Rishya M, et al. Serological cross-reactivity among common flaviviruses. Front Cell Infect Microbiol. 2022 Sep;12:975398. doi: https://doi.org/10.3389/fcimb.2022.975398
Köpke C, Schneitler S. First clinical experiences with the Qdenga® vaccine in Germany: a multicentric TravelMedVac study. Presented as Free Communication at the Northern European Conference on Travel Medicine (NECTM9), Copenhagen, Denmark, May 22-24, 2024.