2010 December 2010

By Eliza Barclay from the December 2010 Edition

Dengue Vaccine Race heats up with Big Human Test

The race to develop a vaccine against dengue fever may be getting a little closer to the finish line. The dengue virus, little known in the United State, is endemic to most countries in the tropics thanks to the Aedes aegypti mosquito, which thrives in pools of standing water.

But if you’ve ever had the illness, you’re unlikely to forget it. Sometimes called “bonebreak fever}, dengue is excruciating with raging fevers accompanied by severe headaches, nausea, and a rash. Years of work on a vaccine appear to be paying off. French pharmaceutical giant Sanofi-Aventis is putting its experimental vaccine into the kind of large clinical test that can produce the evidence needed to gain regulatory approval. This comes on the heels of what it claims were several successful smaller trials in Asia and Latin America. The latest study, being conducted in Australia, is expected to take two years to finish .

The World Health Organization estimates that 2.5 billion people worldwide are at risk of getting dengue, and most of them are in Asia and Latin America. But it’s also on the rise in Florida and Texas; Key West has reported 57 cases in the last two years. And on Thursday, Miami-Dade County health officials had ominous news of their own: confirmation of the first “locally acquired” case there.

A man helps his dengue fever stricken daughter in Tegucigalpa, Honduras.
In June, Honduran authorities declared a state of emergency due to the high rate of
dengue cases reported around the country.

At this stage, the dengue vaccine race lacks some of the unexpected twists and bitter rivalries of the polio more vaccine race, but it’s gotten steadily interesting as more heavy hitters take the field.

Aside from Sanofi, GlaxoSmithKline is conducting trials in Thailand, the United States, and Puerto Rico, while the U.S. government threw its hat into the ring with an announcement in August from the National Institutes of Health that it would start its own tests. And don’t underestimate dark horse Brazil: it’s Instituto Butantan, best known for a snake farm where researchers milk snakes to make anti-venoms, is now running its own trials with the NIH strains.

Every year there are 250,000 to 500,000 cases of severe cases of dengue and more than 20,000 deaths, typically from the worst permutation of the disease called dengue hemorrhagic fever, according to the World Health Organization. There is no treatment for any version of it. Most of the vaccines in trials right now are tetravalent, meaning that they aim to protect against all four dengue viruses, or serotypes. Safety concerns about tetravalents had slowed down the race, but Sanofi’s dengue honcho Jean Lang tells Shots that its results in proof-of-concept studies showed the vaccine is “safe and well-tolerated” and that it produced a solid immune response against all four types of dengue viruses after three doses.

George Washington University’s Dr. Peter Hotez, who is president of the Sabin Vaccine Institute, says the spread of dengue in middle-income countries like Singapore and Brazil had added a lot of urgency. “It’s a pleasant surprise that dengue has now piqued the interest of two large pharmaceutical companies,” he says. Does Hotez see take a gander at a possible winner? No. “There really could be multiple victors,” he said.

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