{"id":930,"date":"2025-02-06T13:42:39","date_gmt":"2025-02-06T13:42:39","guid":{"rendered":"https:\/\/microregistrar.com\/?p=930"},"modified":"2025-02-06T13:42:40","modified_gmt":"2025-02-06T13:42:40","slug":"dengue-vaccine-greenbook-summary","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=930","title":{"rendered":"Dengue vaccine &#8211; Greenbook Summary"},"content":{"rendered":"\n<h3 class=\"wp-block-heading\"><strong>Vaccine Description and Composition<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Type:<\/strong> Qdenga\u00ae is a tetravalent live attenuated vaccine, meaning it uses a weakened form of the virus to stimulate an immune response.<\/li>\n\n\n\n<li><strong>Production:<\/strong> It is produced using recombinant DNA technology in Vero cells.<\/li>\n\n\n\n<li><strong>Serotypes:<\/strong> The vaccine contains serotype-specific surface protein genes from all four dengue serotypes, engineered into a dengue type 2 backbone. This means it aims to protect against all four types of the dengue virus.<\/li>\n\n\n\n<li><strong>Availability:<\/strong> Qdenga\u00ae is available in the UK, unlike another dengue vaccine, Dengvaxia, which is not available in the UK and should not be interchanged.<\/li>\n<\/ul>\n\n\n\n<p><em>&#8220;The dengue vaccination Qdenga\u00ae is a tetravalent live attenuated vaccine. It is produced in Vero cells by recombinant DNA technology and contains serotype-specific surface protein genes of the four dengue serotypes, engineered into a dengue type 2 backbone.&#8221;<\/em><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Storage and Presentation<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Storage:<\/strong> Qdenga\u00ae must be stored in its original packaging at +2\u00b0C to +8\u00b0C, protected from light. Temperature control is critical to maintain the vaccine&#8217;s potency. Freezing should be avoided.<\/li>\n<\/ul>\n\n\n\n<p><em>&#8220;Vaccines should be stored in the original packaging at +2C\u030a to +8C\u030a and protected from light&#8230; Heat speeds up the decline in potency of most vaccines&#8230; Freezing may cause increased reactogenicity and loss of potency&#8221;<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Presentation:<\/strong> The vaccine is presented as a freeze-dried powder (a &#8220;compact cake&#8221;) that requires reconstitution with a clear, colourless solvent before use.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Dosage and Administration<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Dosage:<\/strong> The standard dose is 0.5 mL.<\/li>\n\n\n\n<li><strong>Schedule:<\/strong> The vaccination schedule consists of two doses, administered at 0 and 3 months. The need for a booster dose is not currently established.<\/li>\n\n\n\n<li><strong>Route of Administration:<\/strong> The vaccine should be administered via subcutaneous injection, preferably in the upper arm in the region of the deltoid.<\/li>\n\n\n\n<li><strong>Co-administration:<\/strong> Qdenga\u00ae can be co-administered with yellow fever, hepatitis A, inactivated, sub-unit or mRNA vaccines at separate sites, preferably in different limbs or at least 2.5cm apart if in the same limb. There is no data available on co-administration with other live vaccines such as MMR.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Recommendations for Use<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Primary Objective:<\/strong> The primary objective of the UK immunisation program is to protect individuals who have <em>previously<\/em> had dengue from a <em>secondary<\/em> infection, which carries a greater risk of severity.<\/li>\n\n\n\n<li><strong>Efficacy:<\/strong> In trials, the vaccine was found to have 86% efficacy against hospitalised dengue and 65% efficacy against virologically confirmed dengue in those with prior infection.<\/li>\n\n\n\n<li><strong>Not Recommended for Seronegative Individuals:<\/strong> The vaccine is <em>not recommended<\/em> for individuals with no prior history of dengue infection (&#8220;seronegative&#8221;) due to a theoretical risk of severe dengue if these individuals are subsequently exposed to DENV3 or DENV4.<\/li>\n\n\n\n<li><strong>Target Population for Vaccination:<\/strong> Vaccination is considered for individuals aged 4 and over with a <em>likely<\/em> history of prior dengue infection who are:\n<ul class=\"wp-block-list\">\n<li>Planning to travel to dengue risk areas or areas with an ongoing outbreak.<\/li>\n\n\n\n<li>Exposed to dengue virus through their work (e.g., laboratory staff).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Delay After Infection:<\/strong> Consider delaying vaccination for one year after a confirmed dengue infection due to short-lived cross-protection following natural infection.<\/li>\n\n\n\n<li><strong> Determining Previous Infection<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Importance:<\/strong> Decisions about vaccination rely on obtaining a reliable history of dengue infection, considering previous travel, illness, vaccination history, and laboratory results.<\/li>\n\n\n\n<li><strong>Laboratory Confirmation:<\/strong> A previous dengue infection is reliably confirmed by a positive PCR test at the time of illness, detecting viral RNA.<\/li>\n\n\n\n<li>Dengue serology (IgM and IgG) results are more complex to interpret due to cross-reactivity with other flaviviruses and vaccinations. A positive IgG alone requires a careful assessment of possible causes, including other flavivirus exposure\/vaccination and travel history. A positive NS1 antigen test should be confirmed by serology 4 weeks later<\/li>\n\n\n\n<li><strong>Clinical History:<\/strong> In the absence of reliable laboratory confirmation, factors such as residence in an endemic area and a history of compatible illness (fever of 2-7 days with 2 or more of: headache, retro-orbital pain, myalgia, arthralgia, rash, thrombocytopenia, leucopenia) can be considered when deciding whether to vaccinate, along with the likelihood of prior exposure.<\/li>\n\n\n\n<li><strong>Uncertainty:<\/strong> Where uncertainty exists, the potential risks of vaccination should be clearly explained.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Referral<\/strong> Cases where PCR test results are positive should be discussed with the Rare and Imported Pathogens Laboratory (RIPL)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Contraindications<\/strong><\/h3>\n\n\n\n<p>Qdenga\u00ae should <em>not<\/em> be given to:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Children under four years of age.<\/li>\n\n\n\n<li>Pregnant or breastfeeding women.<\/li>\n\n\n\n<li>Individuals with primary or acquired immunodeficiency (including symptomatic or impaired immune function with asymptomatic HIV).<\/li>\n\n\n\n<li>Individuals who are immunosuppressed due to treatment (e.g., high-dose systemic steroids, immunosuppressive biological therapy).<\/li>\n\n\n\n<li>Individuals with a history of anaphylactic reaction to a previous dose or any component of the vaccine.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Precautions<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Vaccination should be postponed in individuals with an acute severe febrile illness.<\/li>\n\n\n\n<li>Women of childbearing potential should avoid pregnancy for at least one month after vaccination.<\/li>\n\n\n\n<li>Consider delaying administration of a Qdenga\u00ae vaccination for a period of one year after a laboratory-confirmed infection.<\/li>\n\n\n\n<li>In exceptional circumstances, vaccination can be considered for seronegative individuals, but specialist advice should be sought.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Adverse Reactions<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Common Reactions:<\/strong> The most commonly reported reactions include injection site pain, headache, myalgia, injection site erythema, malaise, asthenia, and fever.<\/li>\n\n\n\n<li><strong>Duration:<\/strong> These reactions are typically mild to moderate in severity, occur within 2 days of vaccination, and last 1-3 days.<\/li>\n\n\n\n<li><strong>Frequency:<\/strong> Adverse reactions are often less frequent after the second injection.<\/li>\n\n\n\n<li><strong>Monitoring<\/strong> As a newly licensed product, the vaccine is under enhanced surveillance (&#8216;black triangle&#8217; status) and all suspected adverse drug reactions (ADRs) should be reported via the yellow card scheme and to the manufacturers, Takeda UK Ltd.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Management of Cases<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Severe Dengue:<\/strong> Acute samples from suspected cases of severe dengue should be sent to the RIPL for investigation. Previous dengue vaccination history should be obtained.<\/li>\n\n\n\n<li><strong>Reporting<\/strong> Healthcare professionals should liaise with their regional Infectious Disease team and report cases of suspected severe dengue following vaccination in line with serious adverse incident guidance.<\/li>\n\n\n\n<li><strong>Treatment:<\/strong> No specific therapy for dengue is available. NSAIDs such as aspirin and ibuprofen should be avoided, as they increase bleeding risk. Severe dengue requires prompt recognition and hospitalisation for supportive treatment.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"572\" src=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2025\/02\/image-1-1024x572.png\" alt=\"\" class=\"wp-image-932\" srcset=\"https:\/\/microregistrar.com\/wp-content\/uploads\/2025\/02\/image-1-1024x572.png 1024w, https:\/\/microregistrar.com\/wp-content\/uploads\/2025\/02\/image-1-300x168.png 300w, https:\/\/microregistrar.com\/wp-content\/uploads\/2025\/02\/image-1-768x429.png 768w, https:\/\/microregistrar.com\/wp-content\/uploads\/2025\/02\/image-1-320x180.png 320w, https:\/\/microregistrar.com\/wp-content\/uploads\/2025\/02\/image-1.png 1279w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Vaccine Description and Composition &#8220;The dengue vaccination Qdenga\u00ae is a tetravalent live attenuated vaccine. It is produced in Vero cells [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":933,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[11],"tags":[190,191,17],"class_list":["post-930","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-vaccine","tag-dengue","tag-greenbook","tag-vaccine"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/930","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=930"}],"version-history":[{"count":1,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/930\/revisions"}],"predecessor-version":[{"id":934,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/930\/revisions\/934"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/media\/933"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=930"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=930"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=930"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}