dengue tetravalent vaccine (live, attenuated): clinical use

Prescribing considerations

• Confirm consistency with official recommendations and assess previous dengue infection and anticipated exposure.
• Review hypersensitivity and vaccination history, immune status, pregnancy and breastfeeding.
• Postpone during acute severe febrile illness, but not solely for a minor infection.
• Explain that protection may be incomplete and mosquito-bite precautions remain necessary.
• Data are absent above age 60 and limited in people with chronic medical conditions.
• Record the product name and batch number.

Contraindications and cautions

• Hypersensitivity to the active substances, excipients or a previous Qdenga injection.
• Congenital or acquired immune deficiency or relevant immunosuppressive treatment.
• Symptomatic HIV infection, or asymptomatic HIV with impaired immune function.
• Pregnancy.
• Breastfeeding.

Monitoring

• Ensure treatment and supervision for anaphylaxis are immediately available.
• Take precautions to prevent injury from vasovagal fainting.
• Advise assessment of dengue symptoms or warning signs despite vaccination.
• Transient vaccine viraemia can produce positive dengue results that cannot distinguish vaccine virus from wild-type infection.
• Report suspected adverse reactions through the Yellow Card Scheme.

Clinical pharmacology

Live attenuated representatives of all four dengue serotypes replicate locally, inducing humoral and cellular immune responses. Conventional pharmacokinetic studies are not applicable.

Formulation and product differences

• Freeze-dried vaccine in a vial with solvent in a pre-filled syringe, supplied with or without separate needles.
• Reconstitute only with the supplied solvent; do not shake or mix with other vaccines in the same syringe.
• After reconstitution, the solution should be clear, colourless to pale yellow and essentially free from particles.