Opinion: we need a dengue vaccine

Pakistani patients affected with dengue fever share beds in a ward at the hospital in Lahore on September 7, 2011.
Credit: ARIF ALI

WASHINGTON and KARACHI, Pakistan — Last week, the United Nations General Assembly held its Summit on Non-Communicable Diseases (NCDs) in New York in order to bring global attention to these diseases and agree on a plan of action to address them.

But while the world was focusing on NCDs, re-emerging in one of the Middle East’s most populous regions was a deadly infectious threat — dengue fever.

Dengue fever spreads rapidly, can have serious complications, and causes an overwhelming burden of illness, leading many to consider it the world’s most important insect-transmitted viral disease.

What’s more, there has been an explosive increase in dengue cases in recent years — from 1.2 million per year in 1998 to up to at least 50 million annual cases today.

Pakistan is reeling from a particularly acute outbreak of dengue fever that has killed over 60 people, with more than 8,000 cases being reported to date.

Schools in Punjab have been closed for the last 10 days, National Institutes of Health officials confirm that dengue is now spreading to other parts of Pakistan, and U.S. consulate officials in Lahore have confirmed that some embassy employees have contracted the virus. Many physicians have also been affected, some seriously and a senior Punjab Secretary lost his life to Dengue fever.

As the world grows more globally interconnected, what happens in someone’s backyard halfway around the globe may soon take place in yours. The number of dengue cases in the Bahamas, for example, continues to increase.

According to the Bahamas minister of health, the country has broken its record for the number of dengue fever cases reported during yearly seasonal outbreaks, with more than 1,500 confirmed cases this year. The Centers for Disease Control has reported that an unspecified but, “higher than usual” number of Americans have returned from the popular vacation destination with symptoms of dengue fever.

Today, dengue is naturally present in more than 100 countries in the Americas, the eastern Mediterranean, Southeast Asia, the western Pacific and Africa — making outbreaks, and even epidemics, a common occurrence.

The immediate risk of a dengue epidemic spreading quickly to other parts of the world should be a signal that infectious diseases must be addressed with concerted efforts from all countries.

It is time for more effective methods of prevention, and for a better understanding of the scope and cost of the problem. Raising awareness about the disease continues to be one of the largest challenges. The mission of the Dengue Vaccine Initiative is to encourage the development and use of vaccines to prevent the estimated 50 million dengue cases that occur annually.

As a consortium of organizations committed to a world without dengue, the vacine initiative is working to lay the groundwork for dengue vaccine introduction in endemic areas so that once licensed, vaccines to prevent dengue will be swiftly adopted by countries most in need.

The need for a dengue vaccine is clear. The most effective means of mosquito control — including changes to human habitation and behavior, and long-lasting modification of natural and man-made mosquito habitats — are difficult to implement and largely unsuccessful in most poverty-stricken settings and therefore have not been carried out comprehensively enough to limit dengue’s spread. While vector control is an integral part of any dengue prevention strategy, it is not enough on its own.

Without a vaccine to prevent dengue, we must redouble our efforts to effectively treat this infectious threat, starting with improving diagnostics. In many parts of Asia, dengue is indistinguishable from typhoid, for example — and more rapidly and effectively diagnosing dengue and its symptoms will help us more quickly and effectively treat those impacted by this painful disease.

But for the first time in recent history, an innovative dengue vaccine is within our reach. A dengue vaccine could be available as early as 2015, providing a much needed public health intervention for this growing, worldwide threat.

To turn a vaccine into a true victory against dengue will require a good deal more work on the part of the international global health community and the governments of endemic countries. Only through a consistent and coordinated approach can we enhance our understanding of dengue and fully realize the potential benefits of this urgently needed vaccine.

The emphasis on the vital role of vaccines in improving health across the world is palpable, and increasing focus on dengue represents a critical opportunity to capitalize on this groundswell of progress.

Dr. Zulfiqar A. Bhutta is Husein Laljee Dewraj Professor and Head of the newly created Division of Maternal and Child Health at the Aga Khan University Medical Center in Karachi, Pakistan. He also holds adjunct professorships in International Health & Family and Community Medicine within the departments of International Health at Boston University and Tufts University (Boston). He was designated a Distinguished National Professor by the Government of Pakistan in 2007.IRO D MD, MPH

Ciro A. de Quadros, MD, MPH is Executive Vice President of the Sabin Vaccine Institute. Before joining the Sabin Vaccine Institute in 2003, Dr. de Quadros was Director of the Division of Vaccines and Immunization at the Pan American Health Organization. He also served as the World Health Organization's Chief Epidemiologist for the Smallpox Eradication Program in Ethiopia from 1970 to 1976.

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