a year in all studies, and SAEs were recorded throughout the trial period. In all of the trials except for Leo, et al., 25 none of the cases of severe adverse effects were considered to be related to the vaccine in test groups. Three patients( 0.3 %) from Leo, et al’ s 25 study experienced relatively severe AEs( fever, rash and worsening of cervical spondylosis related to vaccination) such that they had to be withdrawn from the study.
4.2. Limitations of the Study
The efficacy measured in this systematic review is based solely on the induction of the immune system due to the dengue vaccine, which is expected to protect the subjects from the virus in the future. However, this systematic review does not provide concrete evidence on the long term efficacy of the vaccine. Several studies have been started on the long term efficacy of the vaccine, but they are still on-going as of July 2016. 17
4.3. Future Research and Applications
The main purpose of developing the CYD-TDV is to prevent the onset of symptomatic dengue disease. Because this systematic review shows that the CYD-TDV is effective and safe in children, this opens possibilities for further exploration of this vaccine in large-scale long term studies to assess its longterm efficacy in decreasing the prevalence of symptomatic dengue disease.
Additionally, from the discussion, it is seen that the high baseline dengue seropositivity rates in populations of Dayan, et al. 20 and Villar, et al. 24 expressed a stronger immune response to the CYD- TDV. It is plausible that this high baseline seropositivity is attributed to the fact that these studies were conducted in the highly endemic regions of Latin America. Indonesia is also considered to be a highly endemic region for dengue virus. Hence, this review gives promise for high efficacy of this vaccine when applied in Indonesian populations.
5. Conclusion
In conclusion, this systematic review confirms that the efficacy( in terms of immunogenicity) and overall safety profile( in terms of reactogenicity) of CYD-TDV are satisfactory. Hence, this review supports the continued development and widespread use of CYD-TDV for the prevention of dengue disease for children and adolescents.
References
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4. Indonesian Health Ministry. Situasi DBD [ Internet ]. Jakarta: Pusat Data dan Informasi Kemenkes RI; 2016 [ cited on 2016 October 20 ]. Available from: http:// www. depkes. go. id / resources / download / pusdatin / infodatin / infodatin-dbd-2016. pdf 5. Indonesian Health Ministry. Wilayah KLB DBD ada di 11 Provinsi [ Internet ]. Jakarta: Biro Komunikasi dan Pelayanan Masyarakat Kemenkes RI; 2016 [ cited on 2016 October 20 ].