Dengue Fever Vaccine

[pixelaoffy]

I have been making enquiries about  a Dengue fever vaccine in Thailand and discovered the one used called Qdenga is avaible . Problem  is it only administered up to 60 years of age . Don't know why. I had Dengue fever last year and what is important to know is you are not immune from being infeceted again . Thailand is getting higher than normal numbers of Dengue fever reported cases even though its not rainy season .

https://www.nationthailand.com/thailand/general/40035336

[Georgealbert]

15 minutes ago, pixelaoffy said:

I have been making enquiries about  a Dengue fever vaccine in Thailand and discovered the one used called Qdenga is avaible . Problem  is it only administered up to 60 years of age . Don't know why. I had Dengue fever last year and what is important to know is you are not immune from being infeceted again . Thailand is getting higher than normal numbers of Dengue fever reported cases even though its not rainy season .

https://www.nationthailand.com/thailand/general/40035336

I asked at Bangkok Pattaya Hospital about the age limit and was told that no research has been carried out in over 60s, so vaccine is not being made available for us seniors.

 

https://www.bangkokhospital.com/en/package/new-type-of-preventive-vaccine-for-dengue-fever

 

“Since Qdenga® has not yet been studied in individuals >60 years old, we advise vaccination should be avoided in this group until data are available.”

 

https://www.sciencedirect.com/science/article/pii/S1477893923000583

[mfinasi]

How many strains are active in Thailand? If you had dengue twice some years ago is it worth getting the vaccine? I heard there are only two strains popular in Thailand many years ago so unless super unlucky unlikely to ever get it again is that correct?  As covid has demonstrated with the retractions, withdrawals, target audience changes, safe and effective for everyone is very fluid term, vaccines aren't exactly a free ride on the body, but at least Pfizer ain't behind this one.. 

 

[JackGats]

One Dengue vaccine is only recommended for people who've had Dengue already, otherwise it does more harm than good.

[AAArdvark]

1 hour ago, JackGats said:

One Dengue vaccine is only recommended for people who've had Dengue already, otherwise it does more harm than good.

Not the new one

[AAArdvark]

 ฿5000 with two shots over 3 months

[HarryWho]

4 hours ago, Georgealbert said:

I asked at Bangkok Pattaya Hospital about the age limit and was told that no research has been carried out in over 60s, so vaccine is not being made available for us seniors.

 

I went there and they told me the same thing.  I am 66, and I asked if I could get despite the lack of evidence. The Dr. said yes, so some doctors might be flexible?  He said it might not prevent it, but if you get it, the symptoms might be less severe.  Who knows.  Might prevent it, might make it less severe, might not.  I got it anyway. No side effects.  I got the Shingles vaccine at the same time.  One in one arm, one in the other.  The Shingles arm was sore for days.

[JackGats]

Qdengua got okayed by the EU for people above 4 years of age. I'll get it. I'll say I am from Europe so never mind I am 65. The Thais love treating people differently on account of citizenship.

[Georgealbert]

14 minutes ago, HarryWho said:

I went there and they told me the same thing.  I am 66, and I asked if I could get despite the lack of evidence. The Dr. said yes, so some doctors might be flexible?  He said it might not prevent it, but if you get it, the symptoms might be less severe.  Who knows.  Might prevent it, might make it less severe, might not.  I got it anyway. No side effects.  I got the Shingles vaccine at the same time.  One in one arm, one in the other.  The Shingles arm was sore for days.

That is good to hear that the doctor was happy to give the vaccine. Did you have to sign anything to say you understood and accept any risks and understood the restrictions.

[HarryWho]

31 minutes ago, Georgealbert said:

That is good to hear that the doctor was happy to give the vaccine. Did you have to sign anything to say you understood and accept any risks and understood the restrictions.

I don't remember signing anything, but could be wrong.  I MIGHT have signed. 🤷‍♂️

[khunPer]

5 hours ago, pixelaoffy said:

I have been making enquiries about  a Dengue fever vaccine in Thailand and discovered the one used called Qdenga is avaible . Problem  is it only administered up to 60 years of age . Don't know why. I had Dengue fever last year and what is important to know is you are not immune from being infeceted again . Thailand is getting higher than normal numbers of Dengue fever reported cases even though its not rainy season .

https://www.nationthailand.com/thailand/general/40035336

Some private clinics and hospitals might vaccinate you; I have an elder retired foreign friend, who just yesterday got vaccinated in a clinic.

 

There are four variants of dengue. You are immune for further infection from to the one you already had. However, you are not immune to the three other variants.

 

You need two vaccinations with Qdenga with three month separation to be covered about 60-80 percent, and around 90 percent for hospitalization.

[bradiston]

Not sure how reliable this is, but posting it FYI only.

 

https://www.bangkokhospital.com/content/dengue-vaccine

[cdemundo]

"After recovering from a first dengue infection, a person is protected from infection with the remaining three dengue serotypes for two to three months. Unfortunately, it is not long-term protection, and after that short period, a person can be infected with any of the remaining three dengue serotypes."

 

https://www.nature.com/scitable/topicpage/host-response-to-the-dengue-virus-22402106/#:~:text=After recovering from a first,the remaining three dengue serotypes.

[Pungdo]

There are actually 5 variants now of Dengue Fever not 4, and as previously stated you only have immunity to the variations you've had, I've had it twice, the 2nd one wasn't anywhere near as bad as the first which was horrific, and I got a full understanding as to why it is referred to as Break Bone disease. 🥴

[PPMMUU]

On 2/9/2024 at 11:20 AM, JackGats said:

One Dengue vaccine is only recommended for people who've had Dengue already, otherwise it does more harm than good.

Not this one.

[PPMMUU]

The reason it is not authorized for use in people older than 60 is because there is no data on whether it is safe for such a population. Any doctor who gives this vaccine to people older than 60 is at risk of legal responsibility if anything bad happens to the recipient. A consent, no matter how strong, cannot protect them from being sued, so I doubt anyone will do so.

 

In the future, there may be emerging information about safety concerns in those older than 60, and the recommendation may change. However, that future is not today.

[ukrules]

On 2/9/2024 at 9:46 AM, mfinasi said:

If you had dengue twice some years ago is it worth getting the vaccine?

 

I heard it gets you hardest when you've had it before, even if you didn't realise that you've had it before - which is a thing.

[ukrules]

On 2/9/2024 at 5:05 PM, Pungdo said:

There are actually 5 variants now of Dengue Fever not 4, and as previously stated you only have immunity to the variations you've had, I've had it twice, the 2nd one wasn't anywhere near as bad as the first which was horrific, and I got a full understanding as to why it is referred to as Break Bone disease. 🥴

 

Interesting, did you undergo antibody testing for all variants?

 

[pixelaoffy]

35 minutes ago, PPMMUU said:

The reason it is not authorized for use in people older than 60 is because there is no data on whether it is safe for such a population. Any doctor who gives this vaccine to people older than 60 is at risk of legal responsibility if anything bad happens to the recipient. A consent, no matter how strong, cannot protect them from being sued, so I doubt anyone will do so.

 

In the future, there may be emerging information about safety concerns in those older than 60, and the recommendation may change. However, that future is not today.

Yes. Best option is to  leave Thailand if cannot get the vaccine by any means. Because you are more vulnerable to the disease  having a weakened immunity as you get older and no protection because manufacturers never tested on over 60's . Its Madness 

[JackGats]

50 minutes ago, PPMMUU said:

Not this one.

Apparently. However, some EU countries still do not recommend it for the non-previously infected. Reason: the older vaccine only proved to be catastrophic for the non-previously infected 3 years after being launched. When was this new vaccine launched?

[Polar Bear]

18 minutes ago, JackGats said:

Apparently. However, some EU countries still do not recommend it for the non-previously infected. Reason: the older vaccine only proved to be catastrophic for the non-previously infected 3 years after being launched. When was this new vaccine launched?

 

Qdenga is authorised in the EU for people who are seropositive or seronegative, but it's not recommended for seronegative tourists because they don't need it, not because of safety concerns. This is because the risk profile is very different in the EU. For (most) people, the first Dengue infection is mild. Many people don't even know they had it. I've given the breakdown on this before, but if you live in Thailand, you can expect to catch Dengue roughly once every 10 years. If you were born here, you are likely to be on your second or third infection by the time you are in your mid-20s. So if you live here long term, even if you have never had Dengue before, statistically, it's highly likely that you are going to get it eventually, and probably more than once. 

Someone living in, say, Germany is not going to catch Dengue locally. If they visit Thailand once a year, every year, staying for a month every time, they could expect to catch Dengue once every 100 years. They would have to be extremely unlucky or wildly reckless with bite prevention hygiene to catch it twice. Since the vaccination is primarily helpful for preventing the potentially very serious effects of a subsequent infection, it's going to be of limited use to them.

Of course, the flip side of that is that if they are a regular visitor, they might not know they are seropositive if they have been infected, but it was mild. So then they would be recommended to get vaccinated, but as they are never likely to be tested, they won't know they need it. Unless they catch again, in which case they might find out the hard way. 

Qdenga is not licensed for over 60s because it hasn't been tested, but it isn't contraindicated. You may well find a private clinic willing to do it, if both sides are happy to accept the potential risk. It's not a decision that should be taken likely, but if you have had 2 infections already, it would certainly be worth speaking to a doctor about your own personal risk profile.

[PPMMUU]

41 minutes ago, JackGats said:

Apparently. However, some EU countries still do not recommend it for the non-previously infected. Reason: the older vaccine only proved to be catastrophic for the non-previously infected 3 years after being launched. When was this new vaccine launched?

A few months.

[SAFETY FIRST]

On 2/9/2024 at 8:53 AM, pixelaoffy said:

I had Dengue fever last year and what is important to know is you are not immune from being infeceted again

I was told there a 4 types of dengue, you need to get all 4 to be immune 

 

[Polar Bear]

On 2/9/2024 at 9:46 AM, mfinasi said:

How many strains are active in Thailand? If you had dengue twice some years ago is it worth getting the vaccine? I heard there are only two strains popular in Thailand many years ago so unless super unlucky unlikely to ever get it again is that correct?  As covid has demonstrated with the retractions, withdrawals, target audience changes, safe and effective for everyone is very fluid term, vaccines aren't exactly a free ride on the body, but at least Pfizer ain't behind this one.. 

 

DENV 1, 2, 3, and 4 are active in Thailand. The fifth strain was only recently identified and is not routinely tested for, so we don't know how prevalent it is anywhere. 

DENV 1 used to be the most common in Thailand, followed by DENV 2, then it switched, and DENV 2 became dominant. DENV 4 is usually the least common everywhere, but it is also potentially the most serious and the one most likely to cause hemorrhagic fever in a subsequent infection. Also, for unknown reasons, people seem to be more susceptible to DENV 4 after having had a previous infection of another strain. DENV 4 is still the least common strain in Thailand, but it's rising and fast, and Bangkok is considered to be one of the highest-risk locations for it globally. There are at least 3 different genotypes of DENV 4 circulating in Bangkok. 

[Polar Bear]

12 minutes ago, PPMMUU said:

A few months.

 It was launched commercially last year, but it's been in large-stage trials (around 30,000 people) for over 5 years. It was developed here in Thailand at Maihdol. 

[K2938]

20 minutes ago, Polar Bear said:

DENV 1 used to be the most common in Thailand, followed by DENV 2, then it switched, and DENV 2 became dominant. DENV 4 is usually the least common everywhere, but it is also potentially the most serious and the one most likely to cause hemorrhagic fever in a subsequent infection. Also, for unknown reasons, people seem to be more susceptible to DENV 4 after having had a previous infection of another strain. DENV 4 is still the least common strain in Thailand, but it's rising and fast, and Bangkok is considered to be one of the highest-risk locations for it globally. There are at least 3 different genotypes of DENV 4 circulating in Bangkok. 

What is the source of your statement on DENV 4?  I am not at all saying that it is not correct, but I have for example seen a Thai study from 2010 which says the opposite:

 

"DENV-2 appears to be marginally associated with more severe dengue disease as evidenced by a significant association with DHF grade I when compared to DENV-1. In addition, we found non-significant trends with other grades of DHF. Restricting the analysis to secondary disease we found DENV-2 and -3 to be twice as likely to result in DHF as DEN-4."

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830471/ )

See also this from Brazil: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1668-y ("The present study found that cases of DENV-2 had a higher proportion of severe dengue than among those of DENV-1 and DENV-4")

[pixelaoffy]

59 minutes ago, Polar Bear said:

 

Qdenga is authorised in the EU for people who are seropositive or seronegative, but it's not recommended for seronegative tourists because they don't need it, not because of safety concerns. This is because the risk profile is very different in the EU. For (most) people, the first Dengue infection is mild. Many people don't even know they had it. I've given the breakdown on this before, but if you live in Thailand, you can expect to catch Dengue roughly once every 10 years. If you were born here, you are likely to be on your second or third infection by the time you are in your mid-20s. So if you live here long term, even if you have never had Dengue before, statistically, it's highly likely that you are going to get it eventually, and probably more than once. 

Someone living in, say, Germany is not going to catch Dengue locally. If they visit Thailand once a year, every year, staying for a month every time, they could expect to catch Dengue once every 100 years. They would have to be extremely unlucky or wildly reckless with bite prevention hygiene to catch it twice. Since the vaccination is primarily helpful for preventing the potentially very serious effects of a subsequent infection, it's going to be of limited use to them.

Of course, the flip side of that is that if they are a regular visitor, they might not know they are seropositive if they have been infected, but it was mild. So then they would be recommended to get vaccinated, but as they are never likely to be tested, they won't know they need it. Unless they catch again, in which case they might find out the hard way. 

Qdenga is not licensed for over 60s because it hasn't been tested, but it isn't contraindicated. You may well find a private clinic willing to do it, if both sides are happy to accept the potential risk. It's not a decision that should be taken likely, but if you have had 2 infections already, it would certainly be worth speaking to a doctor about your own personal risk profile.

Surely theres no 'potential risk' other than the  vaccine not being protective !

[Polar Bear]

It was from Mahidol, but the site seems to be down at the moment, so I can't get the link. I'll try to remember to post it later. 

This is an older paper, https://doi.org/10.1016/j.virol.2004.08.003

But it's going to depend what you are looking for and where you look. India has its own genotypes of all strains, and there are really nasty variants of DENV 1 and DENV 2 circulating there at the moment.

DENV 4 doesn't generally circulate in Brazil, but they have sporadic outbreaks which usually results in a short epidemic. The last one I know of was about 10 years ago, but there may have been more recent ones because I don't particularly follow the literature from Brazil, so that might be out of date.

[Polar Bear]

3 minutes ago, pixelaoffy said:

Surely theres no 'potential risk' other than the  vaccine not being protective !

 

That would be my guess, that it would just potentially be less effective, but there could be other issues. Yellow Fever vaccine has a higher rate of adverse effects in people over 60, and some variants of the flu vaccine increase stroke risk in over-85s. But as Qdenga hasn't been tested in over 60s yet, the best you will find is anecdotal evidence. 

[pixelaoffy]

1 hour ago, Polar Bear said:

 

That would be my guess, that it would just potentially be less effective, but there could be other issues. Yellow Fever vaccine has a higher rate of adverse effects in people over 60, and some variants of the flu vaccine increase stroke risk in over-85s. But as Qdenga hasn't been tested in over 60s yet, the best you will find is anecdotal evidence. 

Had a Qdenga vaccine at a clinic tonight after a discussion with doctor. He told me its a commercial reason why it wasn't tested in over 60s and the.only problem as you get later into 60's and older is the effectiveness issue.