ArticleVaccine2020
Ethics of a partially effective dengue vaccine: Lessons from the Philippines.
Article in Vaccine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
34 citing papers in PubMed, 1 synthesis or guideline pooled it, 74 citations in OpenAlex.
- Mathematical models for dengue fever epidemiology: A 10-year systematic review.Physics of life reviews · 2022Pooled it
- Dengue Vaccines.Current topics in microbiology and immunology · 2026Review
- Impact of Specific Pattern Mutations on Plaque Formation and Attenuation Properties of Dengue Virus Serotype 3.Advances in virology · 2026Article
- Protective envelope dimer epitope-like antibodies are elicited against dengue virus in children after infection and vaccination.Science translational medicine · 2025Article
- Advancements in dengue vaccines: A historical overview and pro-spects for following next-generation candidates.Journal of microbiology (Seoul, Korea) · 2025Review
- The interaction of Orthoflavivirus nonstructural proteins 3 and 5 with human fatty acid synthase.PloS one · 2025Article
- Perceptions of dengue risk and acceptability of a dengue vaccine in residents of Puerto Rico.Human vaccines & immunotherapeutics · 2024Article
- Genetic diversity of dengue virus circulating in the Philippines (2014-2019) and comparison with dengue vaccine strains.PLoS neglected tropical diseases · 2024Article
- Immunomodulation in dengue: towards deciphering dengue severity markers.Cell communication and signaling : CCS · 2024Review
- The Flavivirus Non-Structural Protein 5 (NS5): Structure, Functions, and Targeting for Development of Vaccines and Therapeutics.Vaccines · 2024Review
- A pre-vaccination immune metabolic interplay determines the protective antibody response to a dengue virus vaccine.Cell reports · 2024Article
- Self-Replicating RNA Derived from the Genomes of Positive-Strand RNA Viruses.Methods in molecular biology (Clifton, N.J.) · 2024Article
- The effect of mixed vaccination rollout strategy: A modelling study.Infectious Disease Modelling · 2023Article
- NS1 Protein N-Linked Glycosylation Site Affects the Virulence and Pathogenesis of Dengue Virus.Vaccines · 2023Article
- Immunologically effective biomaterials-enhanced vaccines against infection of pathogenic microorganisms.Biosafety and health · 2023Review
- Identification of prior dengue-naïve Dengvaxia recipients with an increased risk for symptomatic dengue during fever surveillance in the Philippines.Frontiers in immunology · 2023Article
- Review
- Pathogen evolution during vaccination campaigns.PLoS biology · 2022Article
- The epidemiology and disease burden of children hospitalized for viral infections within the family Flaviviridae in China: A national cross-sectional study.PLoS neglected tropical diseases · 2022Article
- Investigation of immune response induction by Japanese encephalitis live-attenuated and chimeric vaccines in mice.MedComm · 2022Article
Corrections and comments
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Authors and funding
7 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Dengvaxia, a chimeric yellow fever tetravalent dengue vaccine developed by SanofiPasteur is widely licensed in dengue-endemic countries. In a large cohort study Dengvaxia was found to partially protect children who had prior dengue virus (DENV) infections but sensitized seronegative children to breakthrough DENV disease of enhanced severity. In 2019, the European Medicines Agency and the US FDA issued licenses that reconciled safety issues by restricting vaccine to individuals with prior dengue infections. Using revised Dengvaxia efficacy and safety data we sought to estimate hospitalized and severe dengue cases among the more than 800,000 9 year-old children vaccinated in the Philippines. Despite an overall vaccine efficacy of 69% during 4 years post-vaccination we project there will be more than one thousand vaccinated seronegative and seropositive children hospitalized for severe dengue. Assisting these children through a program of enhanced surveillance leading to improved care deserves widespread support. Clinical responses observed during breakthrough dengue infections in vaccinated individuals counsel prudence in design of vaccine policies. Recommendations concerning continued use of this dengue vaccine are: (1) obtain a better definition of vaccine efficacy and safety through enhanced phase 4 surveillance, (2) obtain a valid, accessible, sensitive, specific and affordable serological test that identifies past wild-type dengue virus infection and (3) clarify safety and efficacy of Dengvaxia in flavivirus immunes. In the absence of an acceptable serological screening test these unresolved ethical issues suggest Dengvaxia be given only to those signing informed consent.
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