Dengue Vaccine Availability and Patient Selection
Yes, there is an FDA-approved dengue vaccine called Dengvaxia (CYD-TDV), but it is only recommended for children and adolescents aged 9-16 years who have laboratory-confirmed previous dengue infection and live in areas where dengue is endemic. 1
Who Should Receive the Dengue Vaccine
Eligibility Criteria (All Must Be Met)
- Age requirement: 9-16 years old 1, 2
- Laboratory confirmation: Must have documented evidence of previous dengue virus infection before vaccination 1, 3
- Geographic requirement: Must be living in areas where dengue is endemic 2, 3
Endemic Areas in the United States
The following U.S. territories are considered endemic for dengue and residents are eligible for vaccination 2:
- Puerto Rico (highest burden with 29,862 cases reported during 2010-2020) 2
- American Samoa (highest incidence rate at 10.2 cases per 1,000 population in 2017) 2
- U.S. Virgin Islands 2
Guam and the Commonwealth of the Northern Mariana Islands have sporadic or uncertain dengue risk and are not considered endemic 2.
Critical Contraindication
Dengvaxia is contraindicated in individuals without laboratory-confirmed previous dengue infection because seronegative children aged 2-5 years have a high risk of severe disease if vaccinated without prior infection 1, 4. This unique requirement makes Dengvaxia one of the first vaccines to require laboratory testing before eligibility 3.
Why This Age Group Benefits Most
Approximately 50.6% of dengue cases in U.S. territories occur in persons aged <20 years, making children and adolescents the population with the highest disease burden 2. The hospitalization rates are substantial: 45.5% in American Samoa, 32.6% in Puerto Rico, and 32.1% in Guam 2. Vaccination in this age group with confirmed previous infection reduces the risk for symptomatic disease, hospitalization, and severe dengue 2, 3.
Important Clinical Pitfalls
- Never vaccinate travelers: Dengvaxia should not be administered to children traveling to or visiting endemic dengue areas—it is only for residents of endemic regions 1
- Laboratory confirmation is mandatory: The vaccine cannot be given based on clinical history alone; serologic testing must document previous dengue infection 1, 3
- Age restrictions are strict: The vaccine is licensed only for ages 9-16 years in the United States 2, 5
Alternative Vaccine (Not FDA-Approved in U.S.)
A second dengue vaccine called Takeda (TAK003) has been approved in the European Union, United Kingdom, Brazil, Argentina, Indonesia, and Thailand, with efficacy of 97.7% against DENV-2 and 73.7% against DENV-1 in children aged 4-16 years 4, 5. However, Takeda has withdrawn its FDA application and is not available in the United States 5.
Practical Implementation Barriers
Healthcare providers should be aware of several barriers to vaccination identified in Puerto Rico 6:
- Cost concerns: Laboratory testing and vaccine costs may not be covered by insurance 6
- Lack of information: Parents and providers need clear education about vaccine eligibility 6
- Vaccine hesitancy: Distrust toward new vaccines and concerns about side effects are common 6
Parents in Puerto Rico indicated willingness to pay a deductible of $5-20 for Dengvaxia when properly educated about the vaccine 6. One-on-one counseling by healthcare providers and educational campaigns through traditional and social media are preferred methods for information dissemination 6.