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Entering the dengue vaccination era: An integrated approach remains essential

image bangkok asian dengue summit for breakdengue

Bangkok was host to the first Asian Dengue Summit where country representatives and experts met to discuss the implementation of integrated approaches to controlling dengue.

How will a new dengue vaccination change how health officials approach outbreak control?  Scientists and experts from 22 countries came together at the two-day Asia Dengue Summit in Bangkok to explore how to harmonize regional integrated efforts and enable coordinated action to combat the growing dengue threat in the region.

Dengue – which causes flu-like symptoms and can develop into the deadly dengue hemorrhagic fever – is the world’s fastest-spreading mosquito-borne disease, with an annual number of cases increasing 30-fold in the last 50 years, and is present in 128 countries. Asia has the highest dengue burden, with an estimated 67 million people contracting the disease each year, causing nearly US$6.5 billion annually in both direct medical and indirect costs. Factors such as increased urbanization, the mobility of populations and climate change exacerbate dengue expansion.

asian dengue summit speaker

Image courtesy of Malaria Consortium

“We see the rising trend in dengue-infectious cases and the current challenge is that it is no longer an urban disease anymore,” said Dr. Raman Velayudhan, the Geneva-based coordinator at WHO’s Department of Control of Neglected Tropical Diseases at the conference.

Dengue vaccination: a new tool in the fight against dengue

With the introduction of the first dengue vaccine in the region, this landscape should be changing in the future. The Philippines, one of the three countries that have approved the dengue vaccine for individuals aged nine to 45 years, will be the first country in Asia to deploy the vaccine. The country is among the most affected, with more than 100,000 cases reported last year.

“Our model of rolling out dengue vaccine is different from traditional practice, which normally rolls from the developed country to the developing country, and from private to public sector,” explained Dr. Josalito Sta Ana, Sanofi Pasteur Regional Head of Dengue, Asia Pacific.

“For dengue, we are flipping the model to prioritize the countries that are in need of the vaccines. We are currently engaging with the government in six other Asian countries to get approval. As dengue is an unmet medical need, using the public model can provide wider coverage and yield better impact.”

panel asian dengue summit break dengue blog

Image courtesy of Malaria Consortium

Dr. In-Kyu Yoon, Director of Dengue Vaccine Initiative (DVI) said: “ The vaccine is part of the integrated approach. There are a number of dengue vaccine candidates in the pipeline, three of them are in the advanced stage. Sanofi Pasteur’s vaccine has now been licensed in three endemic countries. The National Institution of Health also has a vaccine candidate that has been approved for phase three trial in Brazil, while Takeda Pharmaceutical is about to enter phase three with their vaccine in development. Clinical development of the next wave of vaccine candidates will need to account the introduction of Sanofi Pasteur’s vaccine in some dengue-endemic countries.”

The need for an integrated approach

While launching the first dengue vaccine could lead to great progress in derailing the disease, effective dengue prevention and control will still require integration of various methods, including surveillance mosquito control.

“The dengue vaccine is a crucial control method, but it is not the sole mechanism to prevent dengue. In line with work on malaria elimination”, said Dr. Velayudhan, “WHO’s five key technical approaches are needed to deconstruct the burden.”

duane gubler speaker asian dengue summit

Image courtesy of Malaria Consortium

“The first dengue vaccine licensed is like the dawn of a new era in the fight against dengue,” said Professor Duane Gubler of the Duke-National University Singapore Graduate Medical School. “There are also other promising new tools in the vector control pipeline, yet none of these new tools are likely to be effective if used alone.”

Discover the economic burden of dengue

“Enhanced surveillance to monitor both diseases and mosquitoes, as well as international mobilization of resources is needed to support the dengue control strategy to reach WHO 2020 dengue objectives. Research is still needed to better understand the disease, its pathogenesis, transmission dynamics, and immunology. The benefit of controlling the Aedes aegypti mosquito will not only help reduce dengue transmission but will also help control other related diseases caused by this vector, such as yellow fever, chikungunya, and zika.”

Dr. Pratab Singhasivanon, Secretary General/Coordinator of SEAMEO TROPMED Network also noted that there is still progress to be made in establishing integrated approaches to vector control, especially when combined with vaccination programs.

“There are two important questions to ask, which is how we measure the tool to identify if it is efficacious enough and/or if we provide a sufficient coverage area to assess the impact. For example, if we introduce the vaccine to the school system, should we also integrate the vector control measurement for the best outcome? How we are going to assess it and what is the system currently in place in each country to help support and manage this?”

Text Image, Asian Dengue Summit 2016 on the dengue vaccination era.

The WHO global strategy goal to reduce the dengue disease burden has a target of at least a 50% reduction in dengue mortality and a minimum of a 25% reduction in dengue morbidity by 2020. over

 

 

ASEAN Dengue Day: A hand in hand fight

ASEAN Dengue Day report from Bangkok, Thailand

Since its first outbreak in the late 1950s in the Philippines and Thailand, dengue has emerged as a public health burden in Southeast Asia and has become a leading cause of hospitalization and death among children in the region. In order to raise awareness and make dengue into a regional priority, the 10 ASEAN countries have designated June 15th as ASEAN Dengue Day. Every year, representatives from each ASEAN country come together to exchange ideas and work toward innovations that will combat the disease.

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MoU Signing

Thai government steps up efforts to reduce dengue

In an effort to reduce the number of dengue cases, the Thai government is not only working at the regional level, but also organized a Memorandum of Understanding (MoU) signing ceremony at the national level to mark this occasion. This MoU serves as a mutual agreement between the Ministry of Public Health, six other ministries, and an administration unit, to achieve dengue prevention goals.

In an effort to reduce the number of dengue cases, the Thai government is not only working at the regional level, but also organized a Memorandum of Understanding (MoU) signing ceremony at the national level to mark this occasion. This MoU serves as a mutual agreement between the Ministry of Public Health, six other ministries, and an administration unit, to achieve dengue prevention goals.

Watch a younger generation join the buzz around dengue prevention

“To protect our people from dengue, the Ministry of Public Health cannot work alone – we must work together with other ministries,” said Dr. Weraphan Suphanchaimat, Vice Minister for Public Health.

“Today is an important day for commemorating the progress we have made in collaborating to achieve the national dengue reduction goal.”

Thailand Big Cleaning Day: Keep, Clean, ClearThe MoU also reaffirms the commitment of the ministries to cooperate with each other to manage resources, knowledge and information sharing, as well as promoting dengue prevention to the public. It will be in effect for four years, from June 15, 2015 until June 15, 2019.

The MoU was signed by the Ministry of Natural Resources and Environment; Ministry of Interior; Ministry of Education; Bangkok Metropolitan Administration; Ministry of Tourism and Sports; Ministry of Culture; Ministry of Industrial; and Ministry of Public Health.

To raise public awareness of the disease, Thai authorities have also launched the “Big Cleaning Day” campaign to target six key areas where the disease can thrive (households, schools, hospitals, hotels, factories, and temples). The three core key messages are “Keep, Clean and Clear.” “Keep” the water containers tightly shut, “Clean” the household area, and “Clear” the garbage away from the community.

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Dr.Weraphan Suphanchaimat, Vice Minister for Public Health and representatives from 7 other ministries at the MoU signing ceremony

Thailand aims to reduce the number of dengue cases by 25% by the end of 2016

The way forward: strengthen collaboration

The ASEAN Dengue Day campaign can be seen as a positive sign, indicating the willingness of policymakers to take action on the dengue situation in the region. However, to achieve dengue case reduction goals, individuals, families, communities, the private sector, non-profit organizations, and the government must work together to fight this disease.

“Dengue is not only Thailand’s challenge, but a regional one,” said Dr. Sopon Mekthon, Director General, and Department of Disease Control Thailand. “75% of the dengue burden can be found in Southeast Asia. ASEAN Dengue Day is a day when we all can be united to fight against our common enemy.”

Art from ASEAN Dengue Day 2016

The “Big Cleaning Day.” An official banner to begin the campaign during ASEAN Dengue Day in Thailand.

Mr. Eric Mansion, the Managing Director from Sanofi Pasteur, said, “From the private sector side, we are also working with different countries to support the government. Dengue is a growing concern in this region. Although it is a disease without any vaccine or cure, it does not mean we cannot do anything. This year on ASEAN Dengue Day, we are working with the government on a campaign called “Dengue Mission Buzz” to launch a mobile education truck to raise awareness and provide dengue education to cover 30 communities in six ASEAN countries.”

“Dengue fever is the fastest emerging disease globally,” added Mr. Henry Braun, Malaria Consortium Asia Programmes Director. “Its epidemiology is rapidly evolving, with increased frequency of outbreaks and expansion to new geographical areas that were previously unaffected. Malaria Consortium is currently working with the governments in the Mekong region to address this health and economic issue and find new innovative ways to reduce the case burden.”

Image of trucks and Eric Mansion, Managing Director from Sanofi Pasteur, ASEAN Dengue Day in Laos

According to the World Health Organization, the total number of dengue cases reported in Southeast Asia is over 100,000. Statistics show the disease has caused deaths in this region, year after year. Children being at the highest risk of contracting the disease.

“It’s about how to survive, how to get well…”

Watch, “The Lingering Effect of Dengue” below