CYD‐TDV (Dengvaxia) use in travellers should be considered on a case‐by‐case basis, with a detailed discussion of risks and benefits in light of its safety and efficacy profile
Dengue has a significant impact on global health and is a leading cause of illness in travellers who visit dengue endemic countries. There are four serotypes of dengue virus, belonging to the Flaviviridae family, that are transmitted to humans by Aedes spp. mosquitoes. Infection with dengue virus can be asymptomatic or cause a self‐limited febrile illness, but can also cause severe infection. Secondary infection is a risk factor for severe dengue and one of the proposed mechanisms is antibody‐dependent enhancement of dengue infection. It has been shown that antibody‐dependent enhancement results from the presence of pre‐existing antibodies arising from a primary dengue virus infection that bind to an infecting dengue virus particle in a secondary infection with a different serotype. This results in an antibody–antigen complex that enhances virus entry and replication in monocytes and increases risk of severe illness.1 A key consideration for the development of an effective dengue vaccine has been how best to achieve efficacy against all four serotypes without significant safety concerns.
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