Dengue is described as a vector-borne disease with increasing public health significance in tropical countries like India. In this context, examine the role of vaccines in disease prevention and the challenges in achieving effective immunisation against dengue.

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Introduction

Dengue, transmitted by Aedes mosquitoes, poses a growing public health challenge in India due to urbanisation, climate change, and inadequate vector control.
While vaccines offer a preventive tool, their role remains complex and evolving.

Role of Vaccines in Dengue Prevention

Reducing Disease Burden

Vaccines can lower incidence, hospitalisation, and mortality, especially in endemic regions
Help reduce pressure on healthcare systems during outbreaks

Complementing Vector Control

Provide an additional layer alongside source reduction, fogging, and surveillance
Useful in high-transmission urban clusters

Targeted Protection

Can be prioritised for high-risk populations and endemic areas
Potential to support outbreak preparedness strategies

Challenges in Effective Dengue Immunisation

Scientific and Immunological Constraints

Presence of four dengue serotypes (DENV 1–4) complicates vaccine design
Risk of Antibody-Dependent Enhancement (ADE) leading to severe disease in some cases
Variable efficacy across age groups and serostatus (previous exposure)

Safety and Efficacy Concerns

Earlier vaccines (e.g., Dengvaxia) showed limited safety in seronegative individuals
Need for pre-vaccination screening, increasing complexity

Operational Challenges

Difficulty in identifying target populations (seropositive vs seronegative)
Integration into Universal Immunisation Programme (UIP) remains limited
Cold chain and last-mile delivery constraints

Economic and Accessibility Issues

High cost of vaccines and screening tests
Limited availability in public health systems

Public Trust and Awareness

Vaccine hesitancy due to past controversies and safety concerns
Lack of awareness regarding benefits and limitations

Way Forward

Advancing Research and Development

Invest in next-generation vaccines with broader and safer efficacy
Support indigenous vaccine development

Strategic Deployment

Use vaccines in high-burden regions with robust surveillance data
Combine with sero-surveys for informed targeting

Strengthening Health Systems

Improve disease surveillance, diagnostics, and reporting systems
Integrate vaccination with vector control programmes

Enhancing Accessibility and Trust

Ensure affordable pricing and public provisioning
Conduct transparent communication and awareness campaigns

Conclusion

Vaccines can play a supportive but not standalone role in dengue prevention.
A multi-pronged strategy combining vaccination, vector control, and public health preparedness is essential to tackle dengue effectively in India.

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