Let’s give dengue vaccine a chance
When the sun is away, dengue mosquitoes play.
The rainy season in the Philippines has become synonymous with “dengue outbreak season.” And while some areas in the metro were still submerged in floodwater brought about by Typhoon Carina, Enteng came along, bringing equally heavy rains to Metro Manila and its neighboring provinces for four straight days.
As we expect more water to pool and be stagnant, the incidence of dengue is sure to rise.
Just last month, the Department of Health reported a 39% increase in dengue cases across the country. From Jan. 1 to Aug. 10, the DOH logged a total of 150,354 dengue cases nationwide.
According to DOH, the number is 39% higher, compared to the 107,953 dengue cases reported during the same period last year.
“A dengue outbreak can potentially impact our healthcare system as it will also increase the demand for healthcare workers. Yes, we have beds, but a lot of these hospitals have beds with only a few healthcare workers. So the ratio of healthcare workers to patients is another challenge,” warns Dr. Rontgene Solante, an infectious disease specialist. “Just like in previous outbreaks, mortality rate also rises.”
In 2018, the Philippines registered the second-highest case fatality rate after Brazil.
“And that really caught the attention of WHO at that time, leading them to investigate the causes (of the high mortality),” recalls Dr. Solante. “And one of the findings was a delay in management. Patients were not able to recognize the warning signs of dengue. When patients finally reached the hospital, it was already too late. The children suffered the most.”
Prevention is key
Caused by four distinct virus serotypes transmitted by mosquitoes, specifically the aedes aegypti, dengue severely affects a great number of people, including children and senior citizens, who require hospitalization every year.
“In the Philippines, we have all four serotypes of dengue. So there’s always a higher risk, even if we say 30 to 40% of dengue cases are asymptomatic,” notes Dr. Solante. “Each of these serotypes, we don’t have any protection against. So in our lifetime, we always have that risk of getting infected by serotypes 1, 2, 3, or 4.”
Severe dengue, also known as dengue hemorrhagic fever, is a potentially deadly complication due to plasma leakage, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. In the case of severe dengue, timely access to appropriate healthcare is critical to reduce the risk of mortality.
As the cases rise, the DOH urged the public and local officials to adopt anti-dengue measures such as the following:
- Search and destroy mosquito breeding sites such as stagnant water.
- Secure self-protection by wearing light-colored clothing.
- Apply insect repellents when able.
- Seek early consultation if symptoms of dengue appear.
- Spray and fog hotspot areas for two consecutive weeks to prevent outbreaks.
Vaccine hesitancy: A global health threat
“And while there is no current cure for dengue, this deadly disease can be prevented through vaccination,” notes Dr. Solante.
Dengue is now a vaccine-preventable disease in Brazil, Indonesia, Malaysia, and Thailand, largely due to their comprehensive strategy, which includes vaccines.
Sadly, the lack of FDA-approved dengue vaccine in the country creates a gap in our holistic efforts to address this seasonal yet urgent public health threat. Add to that, the global vaccine hesitancy.
Vaccine hesitancy is defined as a “delay in acceptance or refusal of safe vaccines despite availability of vaccine services” by WHO.
“Vaccine hesitancy remains a global issue,” stresses Dr. Solante. “It’s not just about the vaccine itself; there are cultural, religious, and social reasons involved.”
In 2019, the WHO named vaccine hesitancy among the top 10 threats to global health.
Vaccine hesitancy has become increasingly relevant with the COVID-19 pandemic, particularly as combating the pandemic is hinged on high rates of vaccine uptake. This is especially difficult in individualistic societies, where resistance to vaccination is particularly prevalent.
It’s challenging to pinpoint one single factor for vaccine hesitancy. Each approach should be tailored to address the main reasons for hesitancy in specific communities or LGUs.
“Local government units play a crucial role in this because they understand the local issues affecting vaccination rates,” Dr. Solante discloses.
The DOH’s catch-up vaccination initiatives are a step in the right direction, but there are also limitations, such as the heavy workload of community healthcare workers. Addressing local issues directly within communities is essential to improving vaccination coverage and spreading accurate information.
“We have to really put vaccination as part of the intervention,” Dr. Solante points out. “We need leaders who are committed to incorporating the vaccine into their health programs. There are new-generation vaccines that can address the increasing cases of dengue in the Philippines.”
Dr. Solante adds: “Filipinos are now more prepared to accept a new dengue vaccine compared to previous years. The COVID-19 vaccination efforts have particularly taught the public an important lesson about the significance of vaccination.”
Again, investing in vector control technologies, digital health solutions, and innovative tools like next-generation dengue vaccines is essential to strengthening our defenses against dengue and reducing its impact on vulnerable populations.