The Immunogenicity and Safety of the Live-Attenuated CYD- Tetravalent Dengue Vaccine ( CYD-TDV ) in Children and Adolescents : A Systematic Review of Randomized Controlled Trials
Raksheeth Agarwal a , Oliver Emmanuel b , Sharon Hanmy Angel c , Angga Wiratama d
a ) Universitas Indonesia – (+ 62 ) 85777808310 , raksheeth @ hotmail . com
b ) Universitas Indonesia – (+ 62 ) 818635925 , oliveremmanuel @ hotmail . com
c ) Universitas Indonesia – (+ 62 ) 81362873803 , sharonhanmyangel @ gmail . com d ) Universitas Indonesia – (+ 62 ) 81291004704 , lokeswaraangga @ gmail . com
1 . Introduction
Dengue disease is caused by one of the four serotypes of dengue virus , namely DENV-1 , DENV-2 , DENV-3 , and DENV-4 . The transmission of the four serotypes is arthropodborne , with the main vector being the mosquito Aedes aegypti . Most of the infections of dengue virus are asymptomatic , but infections can also cause diseases ranging from a mild fever to a shock syndrome , which can be lethal . Even though infection with one serotype provides immunity against it for life , disease can subsequently be caused
again by other serotypes in later life . 1
In recent decades , the incidence of dengue has increased dramatically across the world . An epidemiological study estimates that 3.9 billion people from 128 countries are at risk
of infection with dengue viruses . 2 One recent estimate reports that there are 390 million dengue infections per year , of which 96 million cases progressed to manifest
clinically . 3
Indonesia experiences a high burden of disease from dengue virus , and is considered an endemic region . The National Health Ministry reports that in 2015 , the incidence of dengue disease amount to 126,675 , with 1229 deaths in Indonesia . This is a drastic
increase from 100,347 cases with 907 deaths reported in 2014 . 4
In January and February of 2016 , Extraordinary Outbreak Events ( Kejadian Luar Biasa ; KLB ) occurred in 12 regencies in Indonesia . 5 This outbreak resulted in 492 cases and 25
deaths in January 2016 , while in February 2016 there were 116 cases with 9 deaths . 5 The term Extraordinary Outbreak Events refers to the outbreak of a disease based on the following criteria : The number of new cases of dengue in a particular month shows an increase of two-fold or more than the average number per month in the previous year ; The incidence of dengue cases in an area that had never occurred ; or The mortality rate of dengue in a specified period showed an increase of 50 % or more compared to the
previous period . 5