Dengue Vaccine Strategy in Children Aged 9 to 17 Years in the French Caribbean

The Dengvaxia® vaccine is being implemented in a difficult context: complex administration of the vaccine with the need to perform a biological test beforehand and to administer 3 vaccine doses, inconsistent efficacy, controversies and legal actions against the manufacturer in some countries where the vaccine has been used in children under 9 years of age, and general mistrust of vaccines, particularly the most recent ones.

In Martinique and Guadeloupe, where dengue circulates in an endo-epidemic mode, outbreaks involving all four DENV serotypes were observed in 1997, 2001, 2005, 2007, 2010 and 2013. Dengue seroprevalence for the region, estimated in 18-70 year old adult blood donors in 2011, was 93.5% (95% CI [91.5-95.1]). It was 86.7% (95% CI [69.3-96.2]) in 18- to 19-year-olds. A single dengue virus infection (primary dengue) was observed in 3% of dengue-positive donors. The remainder had been infected with two or more dengue viruses. To date, no such seroprevalence data exists for individuals aged 9 to 17 years in these regions, hence the DengueSEA study.

At the same time, a survey on the acceptability of dengue vaccination, conducted among parents/legal guardians of participating children/adolescents will allow the assessment of the degree of vaccine hesitancy, particularly for Dengvaxia®, and to identify its main determinants.

In addition, Martinique and Guadeloupe were affected in 2016 by an epidemic of the Zika virus infection, which affected 50 to 60% of the population. The antigenic relationship between dengue and Zika viruses can be the cause of serological cross-reactions and could have an impact on the efficacy and tolerance of dengue vaccines in individuals with a history of Zika virus infection. This justifies the conduct of a joint seroprevalence study of Zika and dengue virus infections in the study population.

The DengueSEA study is a key towards the implementation of an optimal dengue vaccination strategy for children aged 9 to 17 years in the French Caribbean. The results of this research will also permit better organization of health care services and better management of medical resources, particularly in anticipation of future dengue epidemics in the region. Potential vaccine acceptability challenges will also be better anticipated. Finally, the constitution of a biological collection will allow the evaluation of future serological tests developed to select eligible individuals for dengue vaccination, notably with Dengvaxia®, and to carry out further seroprevalence studies on arboviruses.

CHILDREN

Inclusion criteria

for children:

• Any child aged 9 to 17 years presenting to one of the hospital departments participating in the study at the University Hospitals of Martinique or Guadeloupe
• Need to take a blood sample or place a peripheral venous line for the management of the child
• Residence in Martinique or Guadeloupe since at least one year
• Information on the study given to the child and his/her parent or legal guardian
• Collection of the parent's or legal guardian's non-objection to the child's participation

Exclusion criteria

for children:

• Presence of fever or suspected acute infection
• Presence of an immune deficiency or any other dysimmune condition

PARENTS

Parental inclusion criteria ("vaccine acceptability" survey)

• Collection of the parent's or legal guardian's non-objection to participate in the Dengvaxia® vaccine acceptability survey
• Comprehension of spoken and written French

Non-inclusion criteria for parents (vaccine acceptability survey)

• None of the above