Dengue fever vac­cine: what you need to know

The Myanmar Times - - The Pulse -

ACCORDING to the World Health Or­ga­ni­za­tion, dengue is the fastest-grow­ing in­fec­tious dis­ease with its in­ci­dence grow­ing 30-fold in 50 years from 1965 to 2015. Half of the world is at risk of get­ting the virus with a yearly es­ti­mate of 96 mil­lion symp­to­matic cases and 500,000 hos­pi­tal­i­sa­tions glob­ally.

In Myan­mar, in­ci­dents of the virus have been on the rise. The Min­istry of Health recorded a 300 per­cent in­crease over the pre­vi­ous year in 2015, and in the first half of 2016, more than 600 cases were re­ported in the Yan­gon Re­gion alone.

There is, how­ever, rea­son for hope. The world’s firstever dengue vac­cine, which has been avail­able for use since last year, has be­come the light at the end of the tun­nel, es­pe­cially for trop­i­cal coun­tries like Myan­mar where many fall prey to the dis­ease an­nu­ally. Mex­ico is the world’s first na­tion to have al­lowed the sale and use of the vac­cine, fol­lowed by the Philip­pines and Brazil. According to Usa Thrisyakorn, pro­fes­sor of pae­di­atrics at Thai­land’s Chu­la­longkorn Univer­sity and chair of the Asian Dengue Vac­ci­na­tion Ad­vo­cacy (ADVA) group, the dengue vac­cine has been li­censed in 13 coun­tries, while ap­proval for sale is soon to fol­low.

Myan­mar isn’t on that list yet, but it can look to its neigh­bours to see how im­ple­men­ta­tion of the vac­cine can best be car­ried out. In Thai­land, stud­ies and re­search in re­la­tion to the dengue vac­cine have been con­sis­tently car­ried out for more than 30 years, es­pe­cially by Mahi­dol Univer­sity. The govern­ment and re­lated pub­lic agen­cies are con­sid­er­ing how the vac­cine should be made avail­able.

“Thai­land’s health­care sys­tem is quite ef­fi­cient in terms of dengue treat­ment,” added Usa. “But it is the re­spon­si­bil­ity of de­ci­sion-mak­ers to see if the vac­cine is worth­while. As an as­sis­tive tool, math­e­mat­i­cal mod­el­ling might come into play to help cal­cu­late if it is worth it.”

Ear­lier this year, the Philip­pines launched the world’s first pub­lic im­mu­ni­sa­tion pro­gram for dengue. The mass vac­ci­na­tion pro­gram is de­signed to ad­min­is­ter the vac­cine to 1 mil­lion nine-year-old school­child­ren. The Philip­pine govern­ment spent 3.5 bil­lion pe­sos (US$170 mil­lion) to ad­min­is­ter the free vac­cines.

Tikki Pang, vis­it­ing pro­fes­sor at Lee Kuan Yew School of Pub­lic Pol­icy, the Na­tional Univer­sity of Sin­ga­pore, and for­mer di­rec­tor of re­search pol­icy and co-op­er­a­tion at the WHO, con­sid­ers the Philip­pines a coun­try that has achieved in manag­ing the im­ple­men­ta­tion the vac­cine quickly.

“The then-pres­i­dent of the Philip­pines [Benigno Aquino III] un­der­stood there was a se­ri­ous prob­lem with dengue,” said Pang. “And this is the first time ever there is a vac­cine. He be­lieved this would help the coun­try in re­duc­ing the num­ber of cases. So it’s a strong po­lit­i­cal com­mit­ment right from a pres­i­dent.”

But will State Coun­sel­lor Daw Aung San Suu Kyi be will­ing to make the same com­mit­ment? If so, Myan­mar may do well to ob­serve the pro­to­cols im­ple­mented by Thai­land, where the vac­cine has been li­censed and is ex­pected to be avail­able for use early next year. Usa won­ders how the vac­cine will be made ac­ces­si­ble – be it through pri­vate hos­pi­tals or a state pro­gram. According to Pang, should Thai­land in­tro­duce the vac­cine to im­mu­nise its pop­u­la­tion, an eq­ui­table access should be the first thing to un­der­line.

“Ev­ery­one should get the vac­cine, not just those who can af­ford to pay,” he said. “So that means it prob­a­bly is go­ing to be up to the govern­ment to pro­vide the fund­ing for pub­lic health im­mu­ni­sa­tion. If it’s avail­able only from pri­vate doc­tors, then many peo­ple can­not af­ford to be vac­ci­nated. There has to be a pol­icy to make the vac­cine ac­ces­si­ble to ev­ery­body re­gard­less of rich or poor.”

“If the Thai govern­ment is not cer­tain about the [vac­cine’s] cost-ef­fec­tive­ness and only al­lows pri­vate hos­pi­tals to sell it, the fore­see­able is­sue here is in terms of in­equal­ity,” added Usa.

De­spite the WHO’s po­si­tion pa­per rec­om­mend­ing the use of the vac­cine in coun­tries or ar­eas where the in­fec­tion is wide­spread, Pang said it’s up to each coun­try to make a de­ci­sion for them­selves.

“The WHO’s main func­tion is to set global stan­dards. So they have pub­lished their po­si­tion in a pa­per where they rec­om­mend the use of the vac­cine in coun­tries or ar­eas where there is a lot of dis­ease. All coun­tries of the world are mem­bers of the WHO so they pay at­ten­tion to what the WHO rec­om­mends.

“How­ever, the fi­nal de­ci­sion to use the vac­cine is the de­ci­sion of the coun­try it­self,” he added. “They can get guid­ance from the WHO but it is the coun­try’s own ex­perts, sci­en­tists and doc­tors who know the sit­u­a­tion of the coun­try best. The fi­nal de­ci­sion to in­tro­duce the vac­cine should be a na­tional de­ci­sion guided by the WHO.”

By 2020, the WHO aims to re­duce the mor­tal­ity rate from dengue in­fec­tion by 50pc. To achieve this, Usa said it is para­mount for coun­tries at risk to fol­low rec­om­mended pro­to­cols.

“There are mainly five pro­to­cols to fol­low,” Usa said. “First, di­ag­no­sis and treat­ments must be fast. Sec­ond is mos­quito con­trol. Then we also need a good data­base and dis­ease sur­veil­lance.

The fourth pro­to­col is with re­gard to con­tin­u­ous re­search to ad­just dengue care and treat­ments. The last one is vac­ci­na­tion.” – The Bangkok Post, ad­di­tional re­port­ing by The Myan­mar Times

Photo: AFP

Mos­qui­toes trans­mit the virus at alarm­ing rates in Yan­gon Re­gion: More than 600 cases were re­ported in the first half of this year.

Photo: EPA

An In­dian medic col­lects a blood sam­ple of a pa­tient sus­pected to be in­fected in New Delhi, In­dia, on Septem­ber 2. The dengue virus is the fastest-grow­ing in­fec­tious dis­ease in the world.

Photo: AFP

A pest-con­trol worker fu­mi­gates an area against Aedes mos­qui­toes which carry the dengue virus at a pub­lic res­i­den­tial es­tate in Sin­ga­pore on Novem­ber 15.

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