As Dengue Cases are Rising in The Philippines, Health Experts Are Calling for Reconsideration of the Use of the Dengvaxia Vaccine.

They have a very short memories regarding the Philippines' tragic Dengvaxia experience. Dengvaxia is not suitable for widespread use; recipients must have had previous laboratory confirmed dengue.

Dengue cases have hit 64,797, up 90% compared to the same period as last year and with 274 deaths up to 25th June 2022.

The Inquirer reports that Government experts are pushing for reconsideration of the use Dengvaxia, and lifting of the current ban on its use, to counter the current dengue outbreak to “prevent hospitalization and severe dengue”.

These experts have very short memories indeed! Dengvaxia was suspended for a reason. That reason has included the deaths of multiple pediatric recipients. Here are 2018 reports on investigations and cases are still ongoing under the Philippines Attorneys Office (PAO). Sanofi, the manufacturer, updated product information to advise again use in persons not previously having confirmed infection.

Dengue fever is unique in that the first infection can modify the immune system in such a way as to predispose to a are more serious illness with a second infection. This is known as pathogenic priming. It turns out that the dengue vaccine can act as the first initial infection, setting up recipients for a catastrophic second illness. CDC clarifies:

….dengue vaccination for children 9 through 16 years old, but only when they have been previously infected with dengue and living in areas where dengue is common.  This previous infection should be confirmed by laboratory testing.  This vaccine is different from other vaccines in that it is only recommended for people who have already been infected with dengue virus.  The reason is that children without previous dengue infection are at increased risk for severe dengue disease and hospitalization if they get dengue after they are vaccinated with Dengvaxia.

Although dengue is a very serious illness, surprisingly is also estimated that up to 3/4 of cases are asymptomatic. For those who get sick, management is typically early and intensive supportive care.

Ivermectin is known as an effective antiviral treatment for dengue. This has also been observed by our local doctors where patients thought to have covid-19 were treated with ivermectin and improved, but were later found to actually have had dengue. There are also local herbal treatments, including tawa tawa that are used for dengue.

Dengvaxia must be used judiciously, if at all, and not put back into widespread use.

Vaccines are not the be all and end all solutions that these experts are pushing. For dengue primary prevention is through mosquito management, and general health promotion. Early recognition and treatment of cases is also important.