ISID 2022: Dengue Updates
The session highlights the clinical trials and collaborations in the context of dengue fever.
The dengue clinical trials across Southeast Asia aim to have a local, regional and global impact on health by leading a locally driven research program. This program aims to understand and reduce the burden of infectious diseases, influence clinical guidelines and public health policy, strengthen scientific culture and capacity and increase public understanding and engagement. Randomized controlled trials are an important influence for these aims. They have a higher threshold of evidence base than other types of study methodology. Rapid urbanization and climate change have been the major contributors to the spread of dengue. Dengue, which is usually self-limiting, can become a critical case and may even cause death. With growing challenges associated with the disease, the prevention and control strategies that can help manage are community-based education programs, biological and chemical control of the vector , vaccines, viral prophylaxis and newer treatments. The Wolbachia program which assessed the Wolbachia infected mosquito deployments showed a 77% efficacy of Wolbachia technology in reducing dengue infection and an 86% protective efficacy of hospitalization for dengue infection.
There are 2 vaccines which are licensed for use in dengue. Dengvaxia (Sanofi Pasteur) is indicated for the prevention of dengue caused by serotypes DENV-1, DENV-2, DENV-3 and DENV-4. It can be to individuals between 9 to 16 years of age with laboratory confirmed previous dengue and living in endemic areas. TAK-003 by Takeda is licensed in Indonesia for the prevention of dengue caused by any serotypes between 6 to 45 years of age. There are several more vaccines under development and usually the phase 3 of the larger trials are being conducted in the endemic areas while phase 1 and 2 are conducted in high income countries. A controlled human infection model is one where the healthy population is intentionally infected with the pathogen to study the efficacy of the vaccines. However, this involves a thorough examination of measures to reduce risks of participants and guidelines for clinical management.
Among trials for therapies, the Metformin as Adjunctive therapy in overweight and obese patients with dengue (Metformin Trial) assesses the safety and tolerability of metformin treatment in overweight and obese dengue patients and study the effects on several clinical, immunological and virological markers of disease severity. The Anakinra trial for dengue patients proposed using inflammatory biomarkers to identify patients at the highest risk of severe dengue. However, the major challenges with Anakinra are the cost and availability.
For future efforts, clinical trials need to be more efficient in terms of those diseases which have made very little or slow progress and in which a number of interventions need to be evaluated. Although trials may be difficult to design or develop, have funding issues, having patient involvement is a key factor for their development and success.
P 06 International Society for Infectious Diseases (ISID) Congress 2022, 17th-20th Nov. 2022, Malaysia
