Acceptability of Hypothetical Dengue Vaccines Among Travelers

Authors

  • Christine M. Benoit BA,

    1. Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, MA, USA
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    • Current addresses:

      Pediatric Diabetes and Endocrinology Research, Children's Hospitals and Clinics of Minnesota, St Paul, MN, USA.

  • William B. MacLeod ScD,

    1. Center for Global Health and Development, Boston University, Boston, MA, USA
    2. Department of International Health, Boston University School of Public Health, Boston, MA, USA
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  • Davidson H. Hamer MD,

    1. Center for Global Health and Development, Boston University, Boston, MA, USA
    2. Department of International Health, Boston University School of Public Health, Boston, MA, USA
    3. Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
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  • Carolina Sanchez-Vegas MD,

    1. Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, MA, USA
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    • 2

      Pediatric Infectious Diseases, Miami Children's Hospital, Miami, FL, USA.

  • Lin H. Chen MD,

    1. Division of Infectious Diseases, Travel Medicine Center, Mount Auburn Hospital, Cambridge, MA, USA
    2. Harvard Medical School, Boston, MA, USA
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  • Mary E. Wilson MD,

    1. Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
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  • Adolf W. Karchmer MD,

    1. Harvard Medical School, Boston, MA, USA
    2. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
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  • Emad Yanni MD, MSc, MA,

    1. Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
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  • Natasha S. Hochberg MD,

    1. Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
    2. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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  • Winnie W. Ooi MD,

    1. Travel and Tropical Medicine Clinic, Lahey Clinic, Burlington, MA, USA
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  • Laura Kogelman MD,

    1. Infectious Disease Clinic, Tufts Medical Center, Boston, MA, USA
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  • Elizabeth D. Barnett MD

    Corresponding author
    1. Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, Boston, MA, USA
    • Corresponding Author: Elizabeth D. Barnett, MD, Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, 670 Albany Street Room 625, Boston, MA 02118, USA. E-mail: ebarnett@bu.edu

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Abstract

Background

Dengue viruses have spread widely in recent decades and cause tens of millions of infections mostly in tropical and subtropical areas. Vaccine candidates are being studied aggressively and may be ready for licensure soon.

Methods

We surveyed patients with past or upcoming travel to dengue-endemic countries to assess rates and determinants of acceptance for four hypothetical dengue vaccines with variable efficacy and adverse event (AE) profiles. Acceptance ratios were calculated for vaccines with varied efficacy and AE risk.

Results

Acceptance of the four hypothetical vaccines ranged from 54% for the vaccine with lower efficacy and serious AE risk to 95% for the vaccine with higher efficacy and minor AE risk. Given equal efficacy, vaccines with lower AE risk were better accepted than those with higher AE risk; given equivalent AE risk, vaccines with higher efficacy were better accepted than those with lower efficacy. History of Japanese encephalitis vaccination was associated with lower vaccine acceptance for one of the hypothetical vaccines. US-born travelers were more likely than non-US born travelers to accept a vaccine with 75% efficacy and a risk of minor AEs (p = 0.003). Compared with North American-born travelers, Asian- and African-born travelers were less likely to accept both vaccines with 75% efficacy.

Conclusions

Most travelers would accept a safe and efficacious dengue vaccine if one were available. Travelers valued fewer potential AEs over increased vaccine efficacy.

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