Understanding dengue pathogenesis: implications for vaccine design


Stephenson, JR; (2005) Understanding dengue pathogenesis: implications for vaccine design. Bulletin of the World Health Organization, 83 (4). p. 308. ISSN 0042-9686

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Abstract

In the second half of the twentieth century dengue spread throughout the tropics, threatening the health of a third of the world's population. Dengue viruses cause 50-100 million cases of acute febrile disease every year, including more than 500 000 reported cases of the severe forms of the disease - dengue haemorrhagic fever and dengue shock syndrome. Attempts to create conventional vaccines have been hampered by the lack of suitable experimental models, the need to provide protection against all four serotypes simultaneously and the possible involvement of virus-specific immune responses in severe disease. The current understanding of dengue pathogenesis is outlined in this review, with special emphasis on the role of the immune response. The suspected involvement of the immune system in increased disease severity and vascular damage has raised concerns about every vaccine design strategy proposed so far. Clearly more research is needed on understanding the correlates of protection and mechanisms of pathogenesis. There is, however, an urgent need to provide a solution to the escalating global public health problems caused by dengue infections. Better disease management, vector control and improved public health measures will help reduce the current disease burden, but a safe and effective vaccine is probably the only long-term solution. Although concerns have been raised about the possible safety and efficacy of both conventional and novel vaccine technologies, the situation is now so acute that it is not possible to wait for the perfect vaccine. Consequently the careful and thorough evaluation of several of the current candidate vaccines may be the best approach to halting the spread of disease.

Item Type: Article
Keywords: dengue virus/pathogenicity/immunology, dengue hemorrhagic, fever/immunology, antibody-dependent enhancement/immunology, T-, lymphocytes/immunology, cross reactions, vaccines, attenuated, review literature, Antibody-dependent enhancement, human endothelial-cells, hemorrhagic-fever, disease severity, flavivirus vaccines, virus, protein, infections, responses, mice
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Immunology and Infection
Research Centre: Vaccine Centre
PubMed ID: 15868023
Web of Science ID: 228251900014
URI: http://researchonline.lshtm.ac.uk/id/eprint/13702

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