Recent trends in climate change have led to increasingly warmer temperatures worldwide. According to the latest data from NASA, the global temperature in 2015 ranks as the warmest on record with 0.87 ° C above the average temperature in
1951-1980. 6 In Indonesia, WHO estimates that the mean annual temperature may rise by 3.8 o C by the year 2100 due to increased carbon emissions. 7
Studies show that with this increase in temperature, the spread of the vector and the
virus will be at a larger extent, potentially increasing the global burden of dengue. 8 Warmer temperatures have been known to affect transmission of dengue in at least 2 ways; by affecting the vector mosquitos and by affecting the virus itself. One study explains that as temperature increases, the rate of larval development increases, the emergence of mature mosquitos quickens, the biting rate of mosquito increases, and
the viral replication time within the mosquitos shortens. 9 A study by Rohani et al. in 2009 found that the time between feeding and viral detection decreased in higher
temperature, from 9 days at 26 ° C to 28 ° C to 5 days at 30 ° C for DENV-1 and DENV-4. 10 Another study explains that a rise in temperature results in a shorter extrinsic incubation period( EIP), that is, the time needed for DENV to become transmissible to another host
after initial infection of a mosquito. 11 The study by Chan and Johansson in 2012 estimated that the average EIP shortens from 15 days at 25 ° C to 6.5 days at 30 ° C. 12
Currently, vector control has been the main strategy in managing dengue. According to WHO, countries should adopt an integrated management approach to vector control in order to optimize the use of resources, efficacy, cost effectiveness, ecological safety and
sustainability. 13 Current control measures target different stages of development of A. aegypti. 14 In Indonesia specifically, dengue prevention is carried out through both
vector control and early warning system. 15 Vector control includes source reduction and elimination of adult mosquitos. The source reduction program is commonly known as“ 3M – Menguras, Menutup dan Mengubur” which means to drain, to close and to bury potential breeding sites of dengue. Additional methods include the utilization of
larvacide powder, and controlling lighting and ventilation in the house. 16
Despite all the existing vector control measures, the global spread of the disease still
persists. 13 The current rise in global temperature may eventually incapacitate these vector control measures to manage dengue incidence. This calls for a more urgent need to introduce a vaccine into the prevention scheme. When integrated with the current vector control, a safe, efficacious and cost-effective vaccine has the potential to significantly improve dengue prevention.
Several dengue vaccines have been developed in the past. However, the one that has shown most promise is the CYD-TDV( Trade name: Dengvaxia), which is a Tetravalent Dengue Vaccine developed by Sanofi Pasteur. This is a live-attenuated chimeric vaccine that contains all four dengue virus antigens( DENV 1-4) with a yellow fever backbone. WHO recommends the introduction of this vaccine in areas where there is a high burden
of dengue disease. 17 As of April 2016, CYD-TDV has been licensed in Mexico, Brazil, El