Dengue Vaccine Singapore

Dengvaxia: Is it for you?

With COVID19 taking more than its fair share of our attention in 2020, it’s easy to forget the danger that is constantly lurking in the background: Dengue.

Dengue Fever is endemic in Singapore, and as of August 2020, the total number of cases has exceeded 20,000. This is by far the worst dengue outbreak in the history of Singapore, beating out the previous record year of 2013.

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Dengue Vaccination Singapore

Dengue Fever has no cure and treatment is mainly supportive. However, it might come as a surprise to some that there is actually a dengue vaccine available in Singapore. One might wonder why hasn’t everyone gone for their dengue vaccination? The story, as it turns out, is not as simple as it meets the eye. Dengue in the era of COVID

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The Vaccine

Dengue is a viral infection spread by mosquitoes and it has 4 subtypes, 1, 2, 3 and 4. This is the main reason why dengue outbreaks come in cycles every 4-5 years, as the prevalent strain of dengue changes. CYD-TVD, sold under the brand name Dengvaxia, is a live attenuated vaccine made using recombinant DNA technology.

Dengvaxia is a weakened but live vaccine that works by triggering an immune response against all 4 sub-type of dengue virus. It is given as 3 doses spaced 6 months apart over the course of a year, as was available as early as 2016. 

The Controversy

The 2017 dengue vaccine controversy in the Philippines involved a vaccination program run by the Phillipine Department of Health and vaccinated school children with Dengvaxia. Some of the children who received the vaccine have never been infected by the dengue virus before.

These children were found to be at risk of developing severe dengue disease with subsequent infection by the virus. The vaccination problem was subsequently terminated after the vaccine manufacturers, Sanofi-Pasteur released a statement stating that Dengvaxia posed risks to individuals vaccinated without having a prior dengue infection.

The Data

Subsequent analysis noted that vaccine efficacy among patients with previous dengue infection proven on blood tests is around 76%, while for patients without any prior dengue infection is around 38.8%. There is also an increased risk of hospitalization and severe dengue in these individuals starting around 30 months after the first dose. 

The postulated reason why Dengvaxia causes severe dengue in unvaccinated patients is due to a phenomenon known as Antibody Dependent Enhancement (ADE). ADE is the consequence of secondary Dengue Infection with a different subtype and the pre-existing antibodies from the first infection causes severe disease which involves shock and bleeding. It appears that the use of Dengvaxia can lead to ADE.

Is Dengvaxia for you?

For patients with previous dengue infection and are willing to go ahead with a blood test for antibodies, it can be definitely useful as we live in Dengue Endemic Singapore. However, for patients without any previous dengue infection, preventive measures like eradication of breeding sites and wearing repellent might still be a better option.

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