Stated plainly by Adam Waickman, an accomplished immunologist at SUNY Upstate Medical University in Syracuse, slowing the dengue virus epidemic is going to take the international collaboration of drug development experts as well as every tool at their disposal.
With more than 4.2 million cases of dengue being reported by October 2023, this mosquito-transmitted disease has more than quadrupled its reach since the early 2000s, and has even evolved from a tropical virus to a global threat.
While there is no official cure for dengue, the virus also known as ‘Breakbone Fever’ does have temporary remedies, such as:
Rest: Getting plenty of sleep is critical for a full recovery from any illness, especially one with symptoms as taxing as dengue
Hydration: Flushing the body with clear liquids such as water, broth or herbal tea can help boost recovery
Pain Relievers & Acetaminophen: Over the counter pain relievers can help reduce fever and relieve minor discomforts caused by dengue
Though these treatments can help lessen the effect of some symptoms, the American Society of Tropical Medicine and Hygiene (ASTMH) recently met to discuss the possibility of a proven cure. The society discussed current efforts in vaccinology, drug development and mosquito control and presented their recent progress.
Dengue Virus Vaccine Development
There are currently 3 dengue virus vaccines being further studied for safety and efficacy on populations who have previously had the disease as well as populations who have not.
A key challenge for dengue vaccine development is the need for one vaccine to protect populations against the current four strains of the disease: DENV-1, DENV-2, DENV-3 and DENV-4.
Dengvaxia
Dengvaxia is a tetravalent, live-attenuated vaccine that was developed by Sanofi. Though this vaccine has been shown to have 60% efficacy, it is only recommended to populations who have previously had the virus.
Dengvaxia is available to populations within American Samoa, Puerto Rico, the U.S. Virgin Islands as well as freely associated states.
QDenga
QDenga was developed by Takeda in Tokyo, Japan and has been shown to be effective and safe within populations who have and have not yet had dengue.
With an efficacy of 73%, QDenga is shown to be more effective than Dengvaxia for strains DENV-1 and DENV-2, however it is less effective for DENV-3 and showed inconclusive results for DENV-4.
TV003
While this vaccine has not yet been released for public use, it is currently being developed by the U.S. National Institute of Allergy and Infectious Diseases and tested on a study population of over 16,000 participants.
According to representatives at the ASTMH conference, subjects that have been observed for 2-5 years have shown overall efficacy of 80%. The study field included volunteers who have and have not yet been infected by dengue, but did lack data for both DENV-3 and DENV-4 as those strains were not circulating as widely during the period of study.
Antiviral Dengue Virus Drug Development
Though there have been multiple studies conducted on DENV NS3 inhibitors within antiviral dengue medications, there is currently only one drug that is under serious consideration.
JNJ-1802
Developed by Janssen in Beerse, Belgium, this pill is currently undergoing a ‘Human Challenge’ trial in which study volunteers were intentionally exposed to a dengue pathogen within an extremely controlled setting for 26 days.
On day 5 of 26, study subjects were injected with the dengue virus and then given either the antiviral study drug or a placebo.
Results showed that 6 of the 10 recipients of the study drug had no detectable virus within their blood throughout the study, while all placebo recipients had significant detectable dengue levels within their blood.
While these promising results supported further research of the medication, this type of treatment is not a realistic cure-all for the majority of affected areas due to the expense of equal distribution. Instead, this drug is slated to be used by people who are planning to travel to areas of high dengue prevalence.
Mosquito Control
While controlling the root of infection may seem like the most efficient way to contain this disease on paper, it has proven to be the most difficult piece of the puzzle to solve.
World Mosquito Program
The WMP has crafted a new method of dengue virus control that involves releasing mosquitoes infected with Wolbachia, a type of bacteria that competes with typically carried diseases such as dengue and zika, which makes the spread of disease more difficult.
This approach to fighting disease with more disease has been reported to work in areas in Columbia, where the release of modified mosquitoes lead to a 94-97% decrease in disease incidence.
Repellants
Smaller, more individual approaches to mosquito control can also be very effective.
The CDC recommends wearing loose, long-sleeve shirts and pants as well as utilizing repellants with the following active ingredients:
- DEET
- Picaridin
- Lemon eucalyptus oil
- IR3535
Altogether, the dengue virus is forcing global brands to work in tandem to find modern treatments. Though we do not yet have a marketable solution, it is an international belief of drug development professionals that we are on the precipice of finding a safe, effective and affordable cure for all.
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