We thank Witte et al. for their succinct explanation of this (re-)emerging infection and the successful work-up of the diagnostic and therapeutic particularities (1). Because of the increasing relevance of dengue in our travel medicine practice, we wish to comment as follows.
As rectified in issue 25/2024 of Deutsches Ärzteblatt on page 832, Qdenga is—in contradiction to what was stated in the original article (1)—not only licensed for persons with a history of a confirmed prior infection, but also for seronegative persons from age 4 years.
The Standing Vaccination Committee (STIKO), by contrast, recommends vaccinating exclusively persons in whom prior infection is confirmed, to protect them against renewed exposure risk. The reason given is that vaccination in dengue-naive persons could—in case of subsequent contact with the dengue virus (DENV)—carry a risk of antibody dependent enhancement (ADE), since the vaccine does not confer protection against all four serotypes. Studies have shown gaps in protection against DENV-3 and DENV-4. In the observation period to date, no indication was seen for a risk of ADE as a result of Qdenga administration, although this cannot be conclusively ruled out.
Different travel medicine institutions have already published statements that deviate from the STIKO recommendation. From the perspective of the Standing Travel Medicine Committee (StAR) in the German Society for Tropical Medicine, Travel Medicine and Global Health (DTG), vaccination should be considered for persons who grew up in dengue endemic regions or lived there for long periods of time and who travel once again into an endemic region, as well as for long-term travelers (2).
In our opinion, given these considerations and with awareness of the incidence at the travel destination, an indication for vaccination beyond the STIKO recommendation (but still within the license authorization) should be defined. Even a single dose seems to confer initial protection, whereas the second dose extends this according to license approval data, but does not strengthen it to a significant extent (3).
Footnotes
Conflict of interest statement
AM received lecture honoraria from RG Gesellschaft für Information und Organisation mbH (an organization providing continuing medical education).
The remaining authors declare that no conflict of interest exists.
References
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