Integrated Control of Dengue Through Vaccines and Vector Control

Asia-Pacific Dengue Prevention Board Meeting Integrated Control of Dengue Through Vaccines and Vector Control Bangkok, Thailand | 18 – 19 October 201...
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Asia-Pacific Dengue Prevention Board Meeting

Integrated Control of Dengue Through Vaccines and Vector Control Bangkok, Thailand | 18 – 19 October 2013

Asia-Pacific Dengue Prevention Board Meeting

Integrated Control of Dengue Through Vaccines and Vector Control Dengue is the most rapidly spreading vector-borne disease. Its incidence has increased more than 30-fold in the past 50 years and it is endemic now in some 128 countries, putting between 2.5 and 4 billion people at risk. At least 500,000 people a year are admitted to hospitals with severe disease and about 25,000 die. Epidemics can overwhelm health services and put enormous strains on households and communities.

The Asia-Pacific Dengue Prevention Board met in Bangkok, Thailand, on 18-19 October 2013 to bring together vaccine experts and vector control specialists in discussions with public health experts, researchers, academics and representatives of the manufacturers of the various candidate dengue vaccines to lay the basis for collaborative and integrated approaches to prevention and control. In particular, progress in vaccine development, advances in vector control, encouraging results from community-based programs and projects, and the formation of new partnerships warranted the harnessing of the two disciplines.

Integrated Control of Dengue Through Vaccines and Vector Control

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CONTEXT

The nature of Aedes aegypti — an urban daytime feeder that breeds in containers and does not fly long distances — demands distinct properties for vector control.

Dengue continues to spread globally, imposing a growing disease burden. Globally, the number of infections each year could be around 390 million (several times higher than the estimate of the World Health Organization, WHO), with nearly 100 million reaching any level of clinical or subclinical severity. Data suggest that the situation in Africa is worse than hitherto supposed. WHO estimates that some 500,000 people with severe dengue require admission to hospital each year, a large proportion of whom are children. About 2.5% of those affected die. Factors favoring the extension of dengue include globalization, growing urbanization and climate change, while the current tight constraints on public health expenditure hinder investment in prevention, surveillance, research and development, and trials. The growing loss of faith in the efficacy of vector control exacerbates matters. No new insecticide or delivery system has been introduced for several decades. Some existing tools, approaches and strategies are deemed to have failed or are considered to be unsustainable. Mosquito vectors are spreading (often through the export of second-hand tires) and invasive species are already present in the USA and Europe. Container-breeding Aedes are difficult to control, especially as their eggs resist desiccation, and breeding sites are often extremely difficult to find. Moreover, the mosquitoes have been shown to develop resistance to insecticides. Progress in many areas of dengue prevention and control has been made, however. Advances include better diagnostics, use of a new case definition, improved clinical management (in all the 10 countries reporting

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at the meeting the case-fatality rate had fallen to 0.2-0.5% and had remained low), integrated vector management, and several vaccine candidates with promising clinical trial results. New insecticides belonging to different, new chemical classes, new or improved traps, genetically modified mosquitoes, and biological control of mosquitoes are under development. Antivirals and therapeutic monoclonal antibodies are also being investigated. Additionally, the potential for synergy with malaria and other vector-borne disease programs is being recognized. New partnerships have been created. Some of the 10 countries represented at the meeting1 highlighted the importance and value of political commitment and leadership, and there is also renewed interest at the international level. Five of WHO’s six regional committees have adopted resolutions to tackle dengue and invasive vectors. WHO has developed a global strategy for dengue prevention and control 2012-2020,2 and chosen vector-borne diseases as the theme for World Health Day 2014. The Innovative Vector Control Consortium (IVCC), founded in 2008, has evolved into a product development partnership to accelerate the creation and delivery of new products and tools, especially in view of growing insecticide resistance, Aedes’ outdoor transmission behaviour, and the costs of implementation and coverage of control methods. The recently created Partnership for Dengue Control aims to eliminate dengue as a public health problem through the use of vaccines, improved vector control approaches and other tools, such as better diagnostics and antiviral agents, in an integrated and synergistic way.

NEW TECHNOLOGOGIES FOR VECTOR CONTROL The nature of Aedes aegypti — an urban daytime feeder that breeds in containers and does not fly long distances — demands distinct properties for vector control. All new technologies must cope with the mosquitoes’ behavior, be easy to use and cost-effective, and overcome existing resistance to pyrethroids and organophosphates. Six technologies that are likely to meet these criteria are in trials. `` New generation spatial repellents, which have met proof-of-principle for malaria, are being evaluated against dengue.

and the release of sterile male Ae. aegypti should decrease the mosquito population, thereby cutting transmission of dengue virus. `` Attractant-bait lethal ovitraps containing an attractant and a larvicide should be well suited for controlling Aedes mosquitoes, and initial field tests give encouraging results. `` Pyriproxifen traps are also well suited to Aedes; they contain a larvicide which the mosquito can then transfer to, and thereby contaminate, its oviposition site. Early tests show that they decrease the rate of emergence of adults.

`` Mosquitoes infected with Wolbachia bacteria block dengue virus replication (and may have a shortened lifespan); their release could reduce the ability to transmit dengue virus, and field trials are under way in Viet Nam.

`` Other gravid Aedes traps are being developed and tested as well as meshes treated with a volatile synthetic pyrethroid metofluthrin that knocks down mosquitoes.

`` Mosquitoes with a specific dominant lethal genetic modification transmit a defective gene to their offspring that renders them infertile,

These new tools will still have to be evaluated against both epidemiological and entomological endpoints.

VACCINE DEVELOPMENT AND TRIALS The progress of candidate dengue vaccines in preclinical and clinical trials was reviewed. Live attenuated, subunit protein and purified inactivated virus candidate vaccines are in clinical trials and virus-vectored, DNA and virus-like particle candidates are in pre-clinical development. Sanofi Pasteur’s live attenuated vaccine based on the yellow fever 17D vaccine is furthest advanced, in Phase 3 trials. It has demonstrated a good safety profile with up to one year follow-up after the third dose, induces neutralizing antibodies to all four virus serotypes, and in one efficacy trial has shown protective efficacy against serotypes 1, 3 and 4.

The vaccine failed to protect against serotype 2 infections and studies are under way to understand better why neutralizing antibodies detected by conventional assays did not correlate with protection against disease. Two other live attenuated vaccines (Takeda’s DENVax and the US National Institutes of Health’s TV003) are in Phase 2 trials. Outstanding issues include the fact that there is no correlate of protection for dengue and the level of vaccine efficacy to interrupt dengue virus transmission in endemic areas is not known. There are grounds for optimism as vaccine development is progressing at a rapid pace.

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COUNTRY PRESENTATIONS Ten countries — Australia (Queensland), Cambodia, Indonesia, Malaysia, Myanmar, Philippines, Singapore, Sri Lanka, Thailand and Viet Nam — presented detailed information on the epidemiology, governmental strategies, organization of the prevention and control system, obstacles to be overcome, and measures being taken such as communitybased approaches.

Australia (North Queensland) The number of cases of imported dengue in northern Queensland has increased in recent years. Ae. aegypti is present throughout the region, and wooden houses are favored resting places, but tires and containers also offer good habitats. Outbreaks of disease occur roughly every 5 years. The authorities rely on a dengue management plan, based on disease surveillance, mosquito surveillance and control (larval control, interior residual spraying and installation of lethal ovitraps), and public education. The use of lethal ovitraps proved successful in an outbreak in Townsville in 2007. New strategies are being used for search-and-destroy operations in residential yards, and trials with Wolbachiainfected mosquitoes are under way. Vector monitoring is routine, and there is concern about the possible introduction of Ae. albopictus across the Torres Straits. Quality assurance, monitoring, financial constraints and the loss or lack of specialist staff remain significant challenges.

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Republic, Singapore and, to a lesser extent, Thailand. The pattern of epidemics follows a 3-5 year cycle. The existing surveillance system generates high-quality data but they come from sentinel sites only and are not representative of the situation throughout the country. Integrated vector control management for dengue includes the following elements: `` Community and school-based activities, including education about the socioeconomic costs of dengue, have been extended, and results show reductions in the number of breeding sites. `` Social mobilization and communication have increased awareness and improved practices. `` For chemical control, temephos and pyrethroid insecticides are still useful, where there is no resistance. `` Among the biological control methods, Bacillus thuringiensis israelensis (Bti), which is expensive but acceptable to communities, and guppy fish, which need supportive community education measures, are still used but Mesocyclops are not. Insect growth regulators are still under study.

Cambodia

`` A recent environmental approach has been to fit chemically treated lids to water containers.

Four serotypes of the virus circulate with types 2 and 3 dominant until 2012 when type 1 reappeared, causing a large outbreak. The incidence declined in 2013 even though it increased in the Lao People’s Democratic

The success of these measures depends on the support and motivation of staff and volunteers, accurate applications of materials, and early case warning.

Asia-Pacific Dengue Prevention Board Meeting

Indonesia With more than 17,000 islands and a population of 245 million, dengue prevention and control present particular challenges. The incidence of dengue has increased since 1990, and the cycle between major outbreaks is about 10 years, with the last occurring in 2007. Nevertheless in 2012 some 90,000 cases and 800 deaths were recorded. All four serotypes of dengue virus are circulating, with types 2 and 3 currently predominant in Jakarta. The Government’s prevention and control strategies include partnerships, empowerment and capacity building. They rely on prompt diagnosis and case management, good reporting, epidemiological investigation and vector control measures, including fogging, larviciding and distribution of insecticide-treated bednets through the malaria program. The vector control policy is based on surveillance, integrated management, community involvement and application of insecticides, and involves local government and several ministries besides the Ministry of Health. The country is renowned for its 3M campaigns,3 aimed at covering and cleaning water containers and burying discarded water containers, but Aedes mosquitoes’ adaptability to human-made environments has allowed it to elude control. For epidemiological surveillance, data are collected from hospitals and primary health care centers. The vector surveillance network relies on regular monitoring by voluntary larvae monitoring officers (jumantik) of larvae numbers and vector resistance. Jumantik are trained at district level and also counsel households, mobilize source reduction activities and report findings. Jumantik are not present in all locations, but in some areas their activities correlate with a marked decline in cases of dengue (even in the absence of a decline in the house index).

Obstacles to be overcome include low rates of community participation, inadequate surveillance, financial constraints and inadequate budgeting at government level, and climate change. Consequently, the social mobilization program (communication for behavioral change, COMBI) will be augmented, the National Working Group for Dengue will be revitalized, partnerships with the education sector will be strengthened and steps will be taken to forge political commitment.

Malaysia Dengue is a permanent item on the agenda of post-cabinet meetings of the Ministry of Health. The national dengue strategic plan (2009-2013), which aimed to halve the number of cases in five years, covered surveillance, outbreak response, integrated vaccine control, case management, social mobilization and communication, as well as research. There are no seroprevalence data. The epidemics over the past decade have followed a two-year cycle, sometimes with two peaks a year, with up to 50,000 cases a year. An improvement was seen in 2011-2013, but, as in other countries in the region, an increase in cases occurred in the second half of 2013 — up to 1200 cases per week. Dengue poses the heaviest communicable disease burden in Malaysia (although tuberculosis is catching up). Most cases (57%) are in people in their productive years (20-49 years). The virus serotype has varied over the past 20 years, but has been mainly types 1, 2 and 3. Dengue is a notifiable disease. There is an established prevention and control system, with reports coming from public and private health facilities; these as well as rumors of infections are verified, validated and investigated. Surveillance and reporting use a web-based system for data collection.

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(Sentinel surveillance in private sector is a validated approach.) A laboratory-based surveillance system is needed. Actions taken on the basis of confirmed reports to district outbreak committees and the Ministry of Health include enforcement, health and cleanliness campaigns, source reduction and fogging. Legally sanctioned enforcement included inspection of more than 3.5 million premises in 2012, of which about 1 in 700 were positive for Aedes, the distribution of US$ 4 million worth of chemicals, and fines imposed in more than 1600 cases for the presence of mosquito-breeding sites. Aedes were often found in construction sites, factories, schools, vacant lots and recreational areas, especially in high-rise, highdensity, low socioeconomic areas, making the targeting of households alone insufficient.

Myanmar Dengue, a notifiable disease, spread rapidly in 2000-2009 to rural and urban areas in almost all states and regions; 24,000 cases were recorded in 2009. There are no seroprevalence data, although it is known that all four serotypes are circulating. The reporting of clinical data is limited. Underreporting exists. The epidemic cycle is generally 3-4 years. The seasonal cycle has been replaced by the occurrence of cases throughout the year. Dengue is predominantly a disease of children, especially 5-9 year olds. Predominant breeding sites habitats are drums and barrels, cement tanks and spiritual flower bowls. The disruption that followed cyclone Nargis in 2008 increased the risk of infectious diseases including dengue. The national strategy aims to establish disease and vector surveillance systems, disease prevention through integrated vector control measures, emergency preparedness, case management, community awareness, and

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stronger health infrastructure and support mechanisms. In practice people do not take personal protective measures. Biological control of vectors is not used, and environmental control is being done through community participation. Mass larviciding with temephos is a simple and effective way to reduce dengue cases, but its success depends on good community education and an associated cleaning campaign. To date, the (high) cost of purchasing the larvicide has been borne by UNICEF. Routine fogging with malathion is instituted upon receipt of a report of a case of dengue. The Government pledges continued commitment to dengue prevention and control, and a dedicated workforce is in place. Areas identified as needing strengthening were emergency preparedness and outbreak response, social mobilization, advocacy and health education (with multisectoral input), partnerships between community and municipal services on source reduction programs, vector surveillance, and monitoring and evaluation of vector control. The use of volunteers in community-based interventions appears to be effective but is still being studied; sustainability of such an approach is the main challenge. At the government level, collaboration between all concerned sectors needs improvement, as does the use of evidence in decision-making. Also, resources are constrained.

Philippines The country is experiencing a continuing epidemic, with 140,000 cases in 2012 and a similar number in the first nine months of 2013, and a relatively high number of deaths (748 and nearly 500 respectively). The Department of Health’s prevention program includes surveillance, social mobilization and research. Source reduction measures have long been authorized and chemical means (including temephos and fenthion) are used against mosquitoes.

Current strategies include “the 4 o’clock habit” of stopping work at 4 p.m. to look for breeding sites, taking appropriate action to eliminate any such sites, and synchronizing activities at the community level. WHO’s COMBI approach is being applied in several centers. The Government is distributing a recently developed type of ovicidal/larvicidal trap to 50,000 households in highly endemic areas, while considering other options such as the use of insecticide-treated curtains in schools and of the biological control agents Bti and Mesocyclops. Insecticide resistance is being monitored. Strengths of the current vector control system include the availability of guidelines, a good training system and materials, and the domestic development of a new mosquito trap. Weaknesses include a piecemeal approach locally, insufficient funding, lack of legislative support, civil conflict in some areas, and the effects of natural disasters.

Singapore Responsibilities for dengue prevention and control are divided between the Ministry of Health, for case surveillance and clinical management, and the National Environmental Agency for surveillance, characterization and control of the vector and the virus, with a 1000-strong dengue inspectorate and an interagency task force led by the Agency to coordinate national vector control efforts. Vector control entails environmental management (breeding sites) including the physical removal of habitats and stagnant water, and chemical and biological control. Methods include source elimination (the favored approach), space spraying, indoor residual spraying, chemical larviciding and application of Bti. Enacted legislation allows owners of premises found with mosquito breeding habitats to be penalized with fines. It also allows the halting of construction work to allow institution of vector control measures and

entry into homes suspected to contain mosquito breeding habitats for inspection. Education outreach and street-cleansing programs, which contribute to the physical removal of breeding habitats, are well established. The main elements of the control strategy are virus surveillance and characterization, risk analysis, preventive checks before traditional periods of peak transmission, encouraging greater timely community participation, and increasing resources for control and community education. Although for decades the house index had fallen and been maintained at very low levels, the incidence of dengue cases started to rise from the 1990s and outbreaks were characterized by 5-7 year cycles. In 2013 the predominant circulating dengue virus changed from serotype 2 to 1 and a major outbreak was experienced, with more than 20,000 cases and several deaths reported. Singapore’s intensive vector control program, well regarded by many, achieved some success in curbing dengue cases since the last major review of the program in 2005. However, it did not prevent the major outbreak in 2013 brought about by the change in the predominant viral serotype. Paradoxically, the better the vector control outcomes, the lower the exposure of the population to dengue virus and, consequently, the more susceptible the population becomes. This result underscores the need for continuous refinements to the vector control program, including establishing a coordinated regional effort to share information and best practices to control and prevent the spread of dengue.  Some of the lessons learnt from the handling of the recent and continuing outbreak include: the importance of using a risk-based approach to help allocate resources; avoiding campaign fatigue; and sustaining workforce motivation. 

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Sri Lanka Substantially more cases have been reported over the past five years than in preceding years, although the number of cases in 2013 to date is the lowest since 2009. The seasonal pattern of two monsoons renders vector control predictable and justifies the holding of two national dengue weeks a year. The Government is implementing a national strategic plan for the period 2011-2015, which includes intersectoral coordination and social mobilization, and in the past three years has allocated US$ 5 million for dengue control. The Ministry of Health hosts a sentinel surveillance website. For vector control the Government uses organophosphates, pyrethroids and, increasingly, Bti, but its activities have not been systematically evaluated. Routine surveillance data do show declining case numbers in areas where control programs have been run. In contrast to other countries in the region, the main containers for mosquito breeding are discarded receptacles (tires and water-storage containers together account for only 14%). Outbreak response includes surveillance, communication and public awareness raising, fogging and source reduction, use of volunteers to visit households and intersectoral collaboration. The COMBI program has been targeted mainly at housewives, school principals and teachers, and traders, with good results. The design of houses without gutters was included in legislation on prevention of mosquito breeding in 2007. That legislation enabled the creation of cleaner living areas and cities, prompting the conclusion that laws can have a place in vector control. The numerous constraints to success include limited capacity for entomological surveillance and vector control and improper disposal of solid waste. Solutions include the 3 R system:

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reduce waste, reuse and recycle. Better coordination and evaluation of interventions are needed. Factors identified for success include: dedicated public leadership, good coordination, active community participation, and, to a certain extent, legal enforcement.

Thailand All four serotypes circulate in the country but in 2013, an epidemic year, types 1, 2 and 3 were predominant. The epidemic cycle seems to be 3-5 years. The Ministry of Public Health instituted an interministerial “war room,” and commitment at the Cabinet level led to multisectoral cooperation. The surveillance system includes private hospitals and clinics, but serological data are not collected regularly or systematically. Surveillance and rapid responses teams operate at all levels from the district upwards. Some 100,000 health volunteers are enrolled for community campaigns, but as their activities are not continuous their effectiveness needs evaluation. Responses to a case are twophased: five months of larvicidal campaigns in parallel with a year-long focus on case care. Fogging was found to be not very effective. Although temephos is used, other approaches are encouraged, such as closing water jars with covers, the use of nets, and biological control (guppies). Intensive activities can halve the number of cases in an outbreak in the year following such campaigns. As with other countries in the region, rainfall appears to have been substantially higher in recent years.

Viet Nam All four dengue virus serotypes are circulating, with types 1 and 2 recently dominant. Most cases of dengue are mild, despite the change of viral serotypes. Both Ae. aegypti and Ae. albopictus are present, with the former (and most cases of disease) are mostly in the south of the country. Many outbreaks of dengue

in the center and south of the country have stretched the capacity of the national public health system. The national surveillance and control program currently has an annual budget of about the equivalent of US$ 5 million. Its strategies include the socialization of dengue control, active prevention and increasing investment. In the short term, the focus is on pilot models, developing networks, engaging health workers, collaborators and the community, and emergency response. For the long term, the focus will be on health education, community-based vector control and environmental improvement. The surveillance system was identified as a priority for improvement. Vector control strategies have four main arms: combining vertical and horizontal approaches; tackling the principal mosquito breeding sites; using Mesocyclops, Wolbachia and fish as biological control agents; and strengthening vector control activities at community and household levels (through collaborators and schools). Much hope is being placed on the use of Wolbachia-infected mosquitoes, which are being field tested on an island. The country is collaborating with Cambodia, Indonesia, Lao People’s Democratic Republic, Philippines and Thailand in looking at the ecological, biological and social factors of dengue

Country Experiences — Summary Overall, the country experiences showed that despite extensive vector control efforts outbreaks of dengue still occur. Larval control has major limitations, and it may be more worthwhile to target adult mosquito populations, especially through means that entice adults to sources of insecticide. The cost of insecticide consumes a large part of vector control budgets, at levels that are not sustainable. Switches in the strain of dengue virus circulating pose a major challenge epidemiologically and in terms of disease burden and control. Responses need communication across countries to facilitate predictions of what is happening around the region. There is strong interest in the countries in using mathematical models to forecast demand and predict impact. Countries both want and need regional support for surveillance and harmonization in areas such as policies and regulatory aspects. Where vector control has worked, intensive community engagement has been identified as a prerequisite for success.

control, using data collected at a tourist site to construct a model for dengue control. Other factors that are being taken into consideration are, as elsewhere in the region: climate change (rainfall has increased considerably in Viet Nam in recent years); urbanization; more rapid transport; and the role of different containers as breeding sites.

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FRAMEWORK FOR VACCINE AND VECTOR CONTROL DELIVERY NEEDS In break-out sessions participants identified possible elements of a framework for vaccine and vector control needs in terms of the cycle of data for decision-making, policy and regulatory decisions, country-level implementation, monitoring and evaluating impact, and enabling factors. The Table summarizes some of the key areas that were identified as needing further information, the type of data needed and some possible responses.4

Above all emphasis was placed on capacity building and training at all levels, covering laboratories, information systems and health systems, and the resuscitation of entomology and professional infrastructures. Enabling factors for many of these activities include awareness and demand generation, equitable financing, coordination and collaboration.

CONCLUDING REMARKS A vaccine against dengue will most likely be introduced within the next few years. Even so, vector control and clinical management will continue to remain priorities for the control of dengue. The integration of vaccination programs with appropriate currently-used or new vector control methods has the potential to eliminate dengue as a public health problem. Yet the present state of knowledge does not

Endnotes 1 Australia (Queensland), Cambodia, Indonesia, Malaysia, Myanmar, Philippines, Singapore, Sri Lanka, Thailand and Viet Nam. 2 World Health Organization. Global strategy for dengue prevention and control 2012-2020. Geneva: World Health Organization, ISBN 978 92 4 150403 4. 3 Menguras, menutup dan mengubur: “Clean/drain, Close/cover and Bury” water containers. 4 This framework was further elaborated at a workshop on a critical assessment of vector control for dengue prevention (Washington DC, 11-12 November 2013) — see: http://www. denguevaccines.org/dengue-prevention-board-meetings

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allow specific recommendations for decision making, policy and regulatory decisions, country level implementation and monitoring and evaluating impact to be made at this time. Countries that choose to introduce dengue vaccines need to undertake preparatory work on: rationalizing the introduction of a vaccine; ensuring that arrangements are in place for implementing the vaccination program; and determining in advance measures to evaluate the impact of the vaccine. That work will need minimum standards for the surveillance of disease and vectors. Participants in the meeting looked to WHO and other entities with expertise, time and resources for help in establishing these standards. A dengue vaccine should be introduced in demonstration sites and, following any necessary modifications as a result of evaluation and feedback (including modeling studies), then introduced in other countries. Vaccines and vector control will need to be used together in order to combat dengue effectively.

TABLE 1. Data for Decision-Making Area for Which Data Are Needed Epidemiology

Examples of Data Needed Virus serotype and genotype Patient data, including age, severity of disease and other clinical data Private sector data Nutritional status, genetic variability

Possible Action Improved surveillance (e.g. UNITEDengue), reporting systems and surveillance making dengue notifiable Facilitate representative coverage; agreed minimum data sets, and uniform standards and definitions Develop sensitive, specific and inexpensive diagnostic tools

Social and environmental aspects: ecological and sociological risks; seasonality and climate change Disease Burden

Disease Control

Cost of illness (socioeconomic and clinical)

Health economic studies

Lost productivity

Household surveys

Public and private costs

International and regional sharing of experience

Return on investment in prevention and control

Better surveillance and diagnostic tools

Cost-effectiveness of vector control

Cost-effectiveness and other health economics studies

Prevention and control program costs

International and regional sharing of experience

Optimal integration of vector control and vaccination

Mathematical modeling

Results of vaccine trials

Involvement of immunization managers in planning for introduction of vaccine

Cost-effectiveness of vaccine Strategy and plans for introducing dengue vaccination into the routine immunization schedule, the optimal timing of vaccination programs

Basic research (e.g. immunology and pathogenesis) Greater roles for entomologists

Likely duration of immunity after vaccination Vector Control

Environmental conditions, seasonality and local epidemiology

Encourage innovation in vector control products and strategies

Vector dynamics — distribution, larvae and adult mosquito densities and other entomological indices such as house index, and prevalence of transovarial transmission

Apply new technologies

Consumer needs and preferences for commercial products, and people’s behavior, understanding and acceptance of vector control methods and tools Factors that contribute to effectiveness of vector control

International tendering for insecticide Foster and sustain community engagement Motivate workforce Identify entomological endpoints that correlate with epidemiological endpoints Rigorously evaluate vector control interventions Encourage and support R&D

Policy-making

Evidence on which to base policies and legislation— from vaccines to vector control

Involve national immunization program managers in policymaking and regulatory processes

Immunization schedules

Encourage liaison and coordination between stakeholders

Vaccine production capacity

Share experience of pilot countries for vaccine introduction and vector control, including community engagement, training, health system strengthening

Access to vaccine and health services Pharmacovigilance Logistics and insecticide purchase Alignment of timelines for the development and implementation of vaccines and new vector control approaches Monitoring and Evaluation

General

Indicators of safety, effectiveness and impact of vaccine and/or vector control

Prepare for post-marketing surveillance, including adverse effects and post-vaccination risks

Progress in implementing existing prevention and control strategies

Monitor the health and safety aspects of insecticides

Analysis of potential usefulness of legislation and the judicious application of laws for environmental control

Ensure regular evaluation and reporting of progress

Strengthen national public health infrastructures

Private sector data

Capacity building

Regional data and regional and multinational approaches

Increase human and financial resources

Networks and partnerships

Promote regional cooperation and guidance

Advocacy and resource mobilization

Foster networking and encourage cooperation and coordination

An evidence-based approach to guide resource allocation at national level

Retain and motivate staff Undertake further mathematical modeling for all aspects, including country-specific scenarios, and share findings

LIST OF PARTICIPANTS

Board Members

Dr. Sri Rezeki S Hadinegoro

Dr. Eng Eong Ooi (Unable to attend)

(Unable to attend) Professor Pediatric Infectious Disease Department of Child Health Faculty of Medicine, University of Indonesia Indonesia

Program Director (Biological Defense) DSO National Laboratories Adjunct Assistant Professor National University of Singapore Singapore

Dr. Paba Palihawadana (Unable to attend) Dr. Jeffrey Hanna Associate Professor Discipline of Public Health & Tropical Medicine School of Public Health, Tropical Medicine & Rehabilitation Sciences, James Cook University Australia

Dr. Rekol Huy Deputy Chief National Dengue Control Program (NDCP) Head, Epidemiological Surveillance and Research Unit Ministry of Health Cambodia

Dr. Jacob T. John (Unable to attend) Advisor Christian Medical College Hospital Kamalakshipuram, Vellore India

Dr. Chong Chee Kheong Director Disease Control Division Ministry of Health Malaysia

Dr. Vu Sinh Nam Deputy Director General Administration of Preventive Medicine Ministry of Health Vietnam

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Chief Epidemiologist Epidemiology Unit, Ministry of Health Sri Lanka

Dr. Pratap Singhasivanon (Unable to attend) Vaccine Trial Center Faculty of Tropical Medicine Mahidol University Thailand

Dr. Enrique Tayag Director IV National Epidemiology Center Department of Health The Philippines

Dr. Hlaing Myat Thu Director (Research) Department of Medical Research Myanmar

Invited Guests (by Board Members) Dr. Mulya Rahma Karyanti Medical staff Division of Tropical Paediatric Infectious Diseases, Department of Child Health Medical Faculty University of Indonesia Indonesia

Invited Guests and Vector Control Experts Mr. Joel Aik

Dr. Scott Ritchie

Head of North West Regional Office Environmental Health Department National Environment Agency (NEA) Singapore

Professorial Research Fellow James Cook University Australia

Dr. Zaw Lin Dr. Ananda Amarasinghe Consultant Epidemiologist Epidemiology Unit Ministry of Health Sri Lanka

Vector Borne Diseases Control Unit Divisional Health Department Mandalay Region Myanmar

Dr. Donald S. Shepard Mr. Geoffrey Coffield Project Leader The Boston Consulting Group USA

Schneider Institutes for Health Policy Heller School, Brandeis University USA

Mr. Ly Sokha Ms. Jessa Deutsch The Boston Consulting Group USA

Entomologist Vector Surveillance and Control National Dengue Control Program (NDCP) Cambodia

Mr. David FitzSimon Scientific Writer UK

Dr. Duane J. Gubler Professor & Director Program on Emerging Infectious Diseases Duke-NUS Graduate Medical School Singapore

Dr. Ferdinand Salazar Department of Medical Entomology Research Institute for Tropical Medicine The Philippines

Dr. Tom McLean Chief Operating Officer Innovative Vector Control Consortium UK

Ms. Sitti Ganefa Pakki Head of Vector Control Sub Directorate Directorate of Vector Borne Disease Control Ministry of Health Indonesia

Dr. Amy Morrison Associate Project Scientist Department of Entomology and Nematology University of California- Davis USA

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Dengue Vaccine Initiative (DVI) Ms. Ana F. Carvalho

Ms. Jacqueline Lim

Director, Special Projects Vaccine Advocacy and Education Sabin Vaccine Institute, USA

Epidemiologist Dengue Vaccine Initiative International Vaccine Institute, Korea

Ms. Samantha Clark

Dr. Ira Longini

Health Economist International Vaccine Access Center John Hopkins Bloomberg School of Public Health, USA

Professor of Biostatistics College of Public Health and Health Professions, and College of Medicine University of Florida, USA

Dr. Dagna Constenla

Ms. Minah Park

Director of Economics and Finance International Vaccine Access Center Associate Scientist John Hopkins Bloomberg School of Public Health, USA

Associate Researcher Dengue Vaccine Initiative International Vaccine Institute, Korea

Dr. Ana Durbin Associate Professor Johns Hopkins Bloomberg School of Public Health, USA

Dr. Georges Thiry Deputy Director General Portfolio Management Acting Director for DVI International Vaccine Institute, Korea

Dr. Kirsten Vannice Dr. Scott Halstead Senior Advisor for DVI, USA

Scientist Initiative for Vaccine Research WHO, Switzerland

Local Participants from Thailand

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Dr. Porntep Chanthavanich

Dr. Anuttaraskdi Ratchatatat

Department of Tropical Pediatrics Faculty of Tropical Medicine Mahidol University, Thailand

Bureau of Vector Borne Disease Department of Disease Control Ministry of Public Health, Thailand

Asia-Pacific Dengue Prevention Board Meeting

Vaccine Developers GlaxoSmithKline

Takeda

Dr. Esthel Marie Van Brackel

Dr. Wolfgang Bender

Vice President Government Affairs and Policy Partnerships GSK Biologicals, Belgium

Takeda Vaccines Global Medical Affairs Takeda Development Center Asia, Pte. Ltd Singapore

Dr. Adrienne Guignard Epidemiologist/Senior Manager GSK Biologicals, Belgium

Dr. Edith Lepine Director and Vaccine Project Leader Dengue Vaccine Development GSK Vaccines

Dr. Emilio Ledesma Vice President and Head Vaccine Value and Health Sciences GSK Vaccines, Asia Pacific

Dr. Caroline Sagaert GSK Vaccines

sanofi pasteur Dr. Joselito Sta Ana Senior Director /Regional Head Asia Pacific Dengue Company sanofi pasteur, Singapore

Dr. Bernadette Hendrickx Chief Medical Officer sanofi pasteur, France

Dr. Jean-Antoine Zinsou Senior Director Vaccination Policy and Advocacy sanofi pasteur, France

Dr. Alexander Schmidt Director Clinical Research & Translational Science Vaccine Discovery & Development GSK Vaccines, Belgium

Dr. Woo-Yun Sohn Area Medical Lead Hybrid Market Vaccine Value and Health Sciences GSK Vaccines, Singapore

Dr. Yongyuth Wangroonsarb Director Clinical R&D and Medical Affairs GSK Vaccines, Thailand

Integrated Control of Dengue Through Vaccines and Vector Control

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OTHER ORGANIZATIONS The Bill & Melinda Gates Foundation

Armed Forces Research Institute of Medical Sciences (AFRIMS)

Dr. Lance K. Gordon

Dr. Alongkot Ponlawat

Director for Neglected Infectious Diseases Global Health Program, USA

Chief, Vector Biology and Control Section Department of Entomology, Thailand

Dr. Anastasia Pantelias

Dr. In-Kyu Yoon

Program Officer Infectious Diseases, USA

Colonel, Medical Corps, U.S. Army Chief, Department of Virology, Thailand

Dr. John Yang

Dr. Ananda Nisalak

Senior Program Officer Global Development Vaccine Delivery, USA

Senior Consultant, Thailand

The World Health Organization (WHO) Dr. Raman Velayudhan Coordinator Vector Ecology and Management Department of Control of Neglected Tropical Diseases (HTM/NTD) World Health Organization, Switzerland

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Asia-Pacific Dengue Prevention Board Meeting

The mission of the Dengue Vaccine Initiative (DVI) is to encourage the development and use of vaccines to prevent dengue — a debilitating and sometimes fatal viral disease which cannot be treated with drugs or antibiotics. As a consortium of organizations committed to preventing dengue, DVI is laying the groundwork for dengue vaccine introduction in endemic areas.