ACIP unanimously recommends dengue vaccine for children aged 9 to 16 years

The Advisory Committee on Immunization Practices voted unanimously to recommend the use of an approved three-dose dengue vaccine for children aged 9 to 16 years who live in endemic areas, by a vote of 14-0.

The ACIP also recommended that the vaccine be covered under the Vaccines for Children (VFC) program for those with lab-confirmed previous dengue infections who live in endemic areas, by a unanimous 14-0 vote.

Dengvaxia (CYD-TDV, Sanofi Pasteur) was approved by the FDA in May 2019 for children aged 9 to 16 years who live in endemic areas, including Puerto Rico, which experienced higher levels of dengue this past year. The three doses should be administered 6 months apart.

The vaccine protects against disease caused by all four dengue serotypes and is approved only for children with laboratory confirmation of a previous dengue infection because the vaccine can act as an initial dengue infection, which would put the child at risk for serious disease if they subsequently acquired an infection naturally.

Dengue has been endemic in Puerto Rico for about 50 years, according to the ACIP’s dengue vaccines work group. It infects roughly 60% of the population by the second decade of life, and 80% by the third.

To receive a vaccine, an individual must test positive for dengue antibodies, but there are only two diagnostic tests that are commercially available to test for the presence of dengue antibodies and neither have been approved by the FDA, according to Robert Atmar, MD, a professor of infectious diseases at the Baylor College of Medicine.

In Puerto Rico, tests must be conducted by a certified lab technician inside a commercial laboratory, but as of March 2020, only two such locations existed on the island.

Although the vaccine is covered through the VFC program, the diagnostic test to confirm whether an individual has dengue antibodies is not. However, the tests may be covered by insurance, Atmar said in a previous interview.

Ines O. Esquilin, MD, a pediatric ID specialist in San Juan, Puerto Rico, gave a presentation on the acceptability of Dengvaxia throughout Puerto Rico.

In an assessment of 1,082 adults from November 2020 to June 2021, Esquilin reported that 84% of individuals said they would receive the dengue vaccine themselves, whereas 83% said they would feel comfortable with their child receiving the vaccine.

However, 11% of participants said they would not receive the vaccine themselves nor allow their children to receive it. Esquilin reported that the respondents all had concerns over the safety of the vaccine.

Yvonne A. Maldonado, MD, FAAP, chair of the AAP’s Committee on Infectious Diseases and professor and chief of the division of infectious diseases at Stanford University School of Medicine, was in attendance and provided a perspective from the academy.

“COVID-19 has taught us one thing, and that is that you have to weigh the risks and benefits,” Maldonado said during the meeting. “I understand that risks sound uncomfortable, but really, the risks here are extremely manageable, albeit there will be a number of administrative obstacles to move through ... clearly dengue is a critical issue that has arisen over the years, especially in tropical areas.”