Impact of Dengue Vaccination on Serological Diagnosis: Insights From Phase III Dengue Vaccine Efficacy Trials

Plennevaux, Eric; Moureau, Annick; Arredondo-Garcı́a, José Luis; Villar, Luis; Pitisuttithum, Punnee; Tran, Ngoc Huu; Bonaparte, Matthew; Chansinghakul, Danaya; Coronel, Diana; L’Azou, Maïna; Ochiai, R. Leon; Toh, Myew–Ling; Noriega, Fernando; Bouckenooghe, Alain

doi:10.1093/cid/cix966

Cited by 17 publications

(14 citation statements)

References 13 publications

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“…While mandating confirmatory testing may increase the specificity of dengue diagnosis, despite recent developments in diagnostics (including the highly-accurate NS1 antigen detection tests) [ 6 ], rapid and accurate laboratory confirmation remains inaccessible in most dengue-endemic regions. Furthermore, cheaper tests such as IgM and IgG serology are likely to become less useful as dengue vaccination programs are rolled out; their already (relatively) low specificity has been demonstrated to fall in vaccinated individuals [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of the WHO clinical definitions for dengue and implications for surveillance: A systematic review and meta-analysis

et al. 2021

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Background Dengue is the world’s most common mosquito-borne virus but remains diagnostically challenging due to its nonspecific presentation. Access to laboratory confirmation is limited and thus most reported figures are based on clinical diagnosis alone, the accuracy of which is uncertain. This systematic review assesses the diagnostic accuracy of the traditional (1997) and revised (2009) WHO clinical case definitions for dengue fever, the basis for most national guidelines. Methodology/Principal findings PubMed, EMBASE, Scopus, OpenGrey, and the annual Dengue Bulletin were searched for studies assessing the diagnostic accuracy of the unmodified clinical criteria. Two reviewers (NR/SL) independently assessed eligibility, extracted data, and evaluated risk of bias using a modified QUADAS-2. Additional records were found by citation network analysis. A meta-analysis was done using a bivariate mixed-effects regression model. Studies that modified criteria were analysed separately. This systematic review protocol was registered on PROSPERO (CRD42020165998). We identified 11 and 12 datasets assessing the 1997 and 2009 definition, respectively, and 6 using modified criteria. Sensitivity was 93% (95% CI: 77–98) and 93% (95% CI: 86–96) for the 1997 and 2009 definitions, respectively. Specificity was 29% (95% CI: 8–65) and 31% (95% CI: 18–48) for the 1997 and 2009 definitions, respectively. Diagnostic performance suffered at the extremes of age. No modification significantly improved accuracy. Conclusions/Significance Diagnostic accuracy of clinical criteria is poor, with significant implications for surveillance and public health responses for dengue control. As the basis for most reported figures, this has relevance to policymakers planning resource allocation and researchers modelling transmission, particularly during COVID-19.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of the WHO clinical definitions for dengue and implications for surveillance: A systematic review and meta-analysis

et al. 2021

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“…Vaccination therefore reduced the specificity of IgM and IgG criteria as diagnostic markers for DENV infection, likely due to the presence of vaccine-induced antibody. This was more pronounced in patients who were seronegative prior to vaccination [186,187]. Antibody to DENV NS1, which is not expressed by the vaccine, has been evaluated in pre-and post-vaccination specimens [185].…”

Section: Differentiating Infection From Vaccinationmentioning

confidence: 99%

Dengue: A review of laboratory diagnostics in the vaccine age

Frazer,

Norton

2024

Journal of Medical Microbiology

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Background. Dengue is an important arboviral infection of considerable public health significance. It occurs in a wide global belt within a variety of tropical regions. The timely laboratory diagnosis of Dengue infection is critical to inform both clinical management and an appropriate public health response. Vaccination against Dengue virus is being introduced in some areas. Discussion. Appropriate diagnostic strategies will vary between laboratories depending on the available resources and skills. Diagnostic methods available include viral culture, the serological detection of Dengue-specific antibodies in using enzyme immunoassays (EIAs), microsphere immunoassays, haemagglutination inhibition or in lateral flow point of care tests. The results of antibody tests may be influenced by prior vaccination and exposure to other flaviviruses. The detection of non-structural protein 1 in serum (NS1) has improved the early diagnosis of Dengue and is available in point-of-care assays in addition to EIAs. Direct detection of viral RNA from blood by PCR is more sensitive than NS1 antigen detection but requires molecular skills and resources. An increasing variety of isothermal nucleic acid detection methods are in development. Timing of specimen collection and choice of test is critical to optimize diagnostic accuracy. Metagenomics and the direct detection by sequencing of viral RNA from blood offers the ability to rapidly type isolates for epidemiologic purposes. Conclusion. The impact of vaccination on immune response must be recognized as it will impact test interpretation and diagnostic algorithms.

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“…Several vaccine clinical trials are in progress, and although some are promising, a comprehensive solution has been elusive. 5,6 A changing climate, increased global movement, and urban expansion have permitted the vector's spread. [7][8][9][10][11] The problem is exacerbated by the lack of efficient and affordable diagnostic tools.…”

Section: Introductionmentioning

confidence: 99%

Surveillance and Epidemiology of Dengue in Medellín, Colombia from 2009 to 2017

Warnes

Santacruz-Sanmartín

Carrillo

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Dengue is the most prevalent arthropod-borne viral disease in humans, primarily transmitted by the Aedes aegypti mosquito. We conducted a descriptive analysis of dengue cases from 2009 to 2017 in Medellín, Colombia, using data available from the Secretariat of Health. We analyzed the burden of outbreak years on the healthcare system, risk of cases exhibiting severe illness, potential disease surveillance problems, gender and age as risk factors, and spatiotemporal patterns of disease occurrence. Our data consisted of 50,083 cases, separated based on whether they were diagnostic test negative, diagnostic test positive (primarily IgM ELISA), clinically confirmed, epidemiologically linked, or probable. We used dengue incidence to analyze epidemiological trends between our study years, related to human movement patterns, between gender and age-groups, and spatiotemporally. We used risk to analyze the severity of dengue cases between the study years. We identified human movement could contributed to dengue spread, and male individuals (incidence rate: 0.86; 95% CI: 0.76–0.96) and individuals younger than 15 years (incidence rate: 1.24; 95% CI: 1.13–1.34) have higher incidence of dengue and located critical parts of the city where dengue incidence was high. Analysis was limited by participant diagnostic information, data concerning circulating strains, and a lack of phylogenetic information. Understanding the characteristics of dengue is a fundamental part of improving the health outcomes of at-risk populations. This analysis will be useful to support studies and initiatives to counteract dengue and provide context to the surveillance data collected by the health authorities in Medellín.

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Impact of Dengue Vaccination on Serological Diagnosis: Insights From Phase III Dengue Vaccine Efficacy Trials

Cited by 17 publications

References 13 publications

Diagnostic accuracy of the WHO clinical definitions for dengue and implications for surveillance: A systematic review and meta-analysis

Diagnostic accuracy of the WHO clinical definitions for dengue and implications for surveillance: A systematic review and meta-analysis

Dengue: A review of laboratory diagnostics in the vaccine age

Surveillance and Epidemiology of Dengue in Medellín, Colombia from 2009 to 2017

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