Dengue, a mosquito-borne disease is dangerous and debilitating. More than 200,000 dengue cases in the country were recorded last year. It is endemic in Africa, the Americas, the Eastern Mediterranean, Asia and Western Pacific. Dengue affects 390 million people annually according to World Health Organization (WHO).
Severe dengue symptoms include headaches, rashes, severe abdominal pain, persistent vomiting, vomiting blood, rapid breathing, and fatigue or restlessness. About 2.5% of people affected by the disease die.
An estimated 500,000 individuals with severe dengue, many are children, require hospitalization each year. A dengue patient is expected to spend an average of P18,000 for medicine and hospitalization.
Dengue vaccine facts
After a long wait, a vaccine that hopes to create immunity from dengue is now available in the Philippines.
In December 2015, Director Marlyn Convocar of the Department of Health (DOH) announced that the vaccine called Dengvaxia passed the test conducted by the Food and Drug Administration (FDA). Dengvaxia is first made commercially available in the Philippines.
Last month, the registration of the vaccine manufactured by French pharmaceutical company Sanofi Pasteur was approved by DOH. The vaccine is reported to have an 80% effectivity rate. It can prevent four types of dengue. People between the ages of 9 to 45 years old have priority when it comes to availing the vaccine.
“The Philippines’ scientific and healthcare communities have been significant collaborators in the development of the first dengue vaccine, participating in all three phases of the clinical study program,” said Olivier Charmeil, CEO of Sanofi Pasteur.
The vaccine took 20 years and $1.8 billion before it was launched for commercial use.
“A vaccine is able to reduce six out of 10 cases, or by 80 percent the risk of hospitalization or 93 percent of the risk of dengue hemorrhagic fever, is a major breakthrough,” Sanofi Pasteur’s VP for dengue Guillaume Leroy said.
In April 2016, Sanofi launched the first public vaccination campaign against dengue, making the Philippines the first Asian country to license the first dengue vaccine. Hundreds of Grade 4 public school students in Marikina city were given the first of three shots of Dengvaxia. The vaccine is given in three doses at a six-month interval.
The vaccination program aims to administer the vaccine to a million public elementary schoolchildren in Metro Manila, Central Luzon, and Southern Tagalog.
The Philippines is the first country to benefit from the first dengue vaccine through the public health system. The government has alloted P3.5-B ($76 million) to administer the free vaccines.
Health Secretary Janette Garin considers the program as a significant breakthrough in public health.
CNN reports that the vaccine is expected to reduce dengue cases in the country by 24% in a span of five years based on a study by the University of the Philippines National Institutes of Health.
Dengue vaccine controversy
Despite WHO’s claim that the vaccine will decrease dengue cases in the country, public health advocates, healthcare workers, academics, and civic organizations have requested DOH to delay the administration of the vaccine to children aged 9 to 10 years old. They have expressed concern about the potential problems with the vaccine, particularly the antibody dependent enhancement (ADE). They said the vaccine could initially decrease the number of mild dengue cases but it could later cause severe dengue.
“The real dengue we are afraid of is severe dengue, not the mild ones,” Dr. Antonio Dans, professor at the University of the Philippines-College of Medicine said. “If a vaccine prevents mild disease but causes severe dengue, we shouldn’t be using it at all,” he added.
Dans said that ADE is being monitored closely by Sanofi. The pharmaceutical company and DOH claimed that ADE was observed among children lower than 9 years old. However, data showed that ADE could affect both younger and older children, and even adults.
“If a vaccine prevents mild disease but causes severe dengue, we shouldn’t be using it at all,” Dans said.
Dr. Anthony Leachon, president of the Philippine College of Physicians Foundation is also not in favor of making the vaccine available to the public at this stage. He strongly recommends waiting for the WHO report from the Strategic Advisory Group of Experts (SAGE) on the vaccine to be completed first. He believes that the study will help protect children from possible negative effects of the vaccine.
Interaksyon reports that DOH assures the people that the vaccine is safe because it is backed up by “more than a decade of efficacy and safety studies across ten countries where dengue is endemic and involving more than 30,000 children from various countries, including the Philippines.”
Child’s death linked to dengue vaccine
An 11-year-old boy named John Paul Rafael, who was given a shot of the Dengvaxia last March 31, 2016 died three days after immunization.
When Rafael developed diarrhea and fever, he was brought to the Bagac Community & Medicare Hospital where he was diagnosed with amoebiasis according to Rappler. He was then admitted to the Isaac Catalina Medical Center because of cough and breathing difficulty. The boy was diagnosed with severe pneumonia, congestive heart failure, and electrolyte imbalance. Rafael was later transferred to the Bataan General Hospital. He died from cardiac arrest on April 11, 2016.
The boy’s relatives blame the administration of dengue vaccine for his death. DOH denies that Rafael’s death is caused by Dengvaxia.
DOH cites that Rafael died due to “pulmonary edema (the abnormal buildup of fluid in the lungs), with congenital heart disease and acute gastroenteritis with moderate dehydration as underlying causes.”
The DOH national adverse event committee of the dengue vaccination program had classified Rafael’s death as “coincidental with the vaccination,” Dr. Jess Fantone, DOH Central Luzon spokesperson said in an Inquirer.net report.
The report also say that the WHO-SAGE vouched for the safety of the dengue vaccine and suggests its use in areas with high cases of dengue among children.