NDLI: Efficacy profile of the CYD-TDV dengue vaccine revealed by Bayesian survival analysis of individual-level phase III data

Content Provider	Directory of Open Access Journals (DOAJ)
Author	Daniel J. Laydon Ilaria Dorigatti Wes R. Hinsley Gemma Nedjati-Gilani Laurent Coudeville Neil M. Ferguson
Abstract	Background: Sanofi-Pasteur's CYD-TDV is the only licensed dengue vaccine. Two phase three trials showed higher efficacy in seropositive than seronegative recipients. Hospital follow-up revealed increased hospitalisation in 2–5- year-old vaccinees, where serostatus and age effects were unresolved. Methods: We fit a survival model to individual-level data from both trials, including year 1 of hospital follow-up. We determine efficacy by age, serostatus, serotype and severity, and examine efficacy duration and vaccine action mechanism. Results: Our modelling indicates that vaccine-induced immunity is long-lived in seropositive recipients, and therefore that vaccinating seropositives gives higher protection than two natural infections. Long-term increased hospitalisation risk outweighs short-lived immunity in seronegatives. Independently of serostatus, transient immunity increases with age, and is highest against serotype 4. Benefit is higher in seropositives, and risk enhancement is greater in seronegatives, against hospitalised disease than against febrile disease. Conclusions: Our results support vaccinating seropositives only. Rapid diagnostic tests would enable viable 'screen-then-vaccinate' programs. Since CYD-TDV acts as a silent infection, long-term safety of other vaccine candidates must be closely monitored. Funding: Bill & Melinda Gates Foundation, National Institute for Health Research, UK Medical Research Council, Wellcome Trust, Royal Society. Clinical trial number: NCT01373281 and NCT01374516.
e-ISSN	2050084X
DOI	10.7554/eLife.65131
Journal	eLife
Volume Number	10
Language	English
Publisher	eLife Sciences Publications Ltd
Publisher Date	2021-01-01
Publisher Place	United Kingdom
Access Restriction	Open
Subject Keyword	Medicine Science Biology (general) Dengue Vaccine Mathematical Modelling Bayesian Statistics Survival Analysis Global Health
Content Type	Text
Resource Type	Article

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