Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Departments of Pediatrics and Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines.
Lancet Child Adolesc Health. 2019 Oct;3(10):734-741. doi: 10.1016/S2352-4642(19)30205-6. Epub 2019 Aug 1.
Dengue viruses are endemic in most tropical and subtropical countries where they produce disease ranging from a mild fever to a severe, potentially fatal vascular permeability syndrome. We reviewed the status of development and testing in children of three vaccines designed to protect against the four dengue viruses. The first dengue virus vaccine, Dengvaxia, now licensed in 20 endemic countries, the EU and the USA, provides protection against severe dengue in seropositive individuals but increases the risk for naive recipients to develop severe dengue and to be hospitalised. We discuss mechanisms and implications of shortcomings of the licensed vaccine and describe the structure and attributes of two other dengue virus vaccines. Based upon human dengue challenge studies, one of these vaccines promises to deliver solid, long-lasting immunity after a single dose. Because dengue virus infections are ubiquitous in residents and visitors to tropical countries, in the absence of a protective vaccine paediatricians should recognise the early signs and clinical presentation of severe dengue, understand its pathophysiology and appropriate management.
登革热病毒在大多数热带和亚热带国家流行，这些国家的登革热患者从轻症发热到严重、潜在致命的血管通透性综合征不等。我们回顾了三种旨在预防四种登革热病毒的疫苗在儿童中的开发和试验情况。第一种登革热病毒疫苗 Dengvaxia 现已在 20 个流行国家、欧盟和美国获得许可，可预防血清阳性个体的重症登革热，但会增加对无免疫力的接种者发生重症登革热和住院的风险。我们讨论了许可疫苗的缺陷的机制和影响，并描述了另外两种登革热病毒疫苗的结构和特性。基于人体登革热挑战研究，其中一种疫苗有望在单次接种后提供可靠、持久的免疫力。由于登革热病毒感染在热带国家的居民和游客中无处不在，如果没有保护疫苗，儿科医生应该认识到重症登革热的早期症状和临床表现，了解其病理生理学和适当的治疗方法。
