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

Preparing for the Use of a Dengue Vaccine in the French Caribbean Islands of Martinique and Guadeloupe : the DengueSEA Study

Dengue fever, an arbovirus transmitted by the Aedes mosquito, is a public health problem in all tropical and subtropical regions of the world. There is currently no antiviral treatment and vector control has shown its limits. The 2018 European marketing authorization of the tetravalent chimeric yellow fever / dengue vaccine (Dengvaxia®) is a major step forward in the fight against the disease. Dengvaxia® is indicated for the prevention of dengue due to serotypes DENV 1-4 in subjects aged 9 to 45 years with a history of infection with the dengue virus and living in endemic areas (seroprevalence of at least 70% in the target population).

Dengue seroprevalence data in the French Caribbean territories of Martinique and Guadeloupe dates back to 2011 and concerns only adult blood donors aged 18 to 70 years. To date, no data exists for individuals aged 9 to 17 years in the region.

In order to implement an optimal vaccine introduction strategy for these territories, the main aim of the DengueSEA study is to estimate the seroprevalence of the Dengue viruses (DENV 1-4) in 9-17 year olds giving a blood sample as part of care in hospital departments of the French Caribbean islands of Martinique and Guadeloupe.

Study Overview

• Status: Recruiting
• Conditions: Infectious Disease; Dengue; Vaccination; Seroprevalence

Detailed Description

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.

• Study Type: Observational
• Enrollment (Estimated): 590

Contacts and Locations

• Study Contact: Name: Véronique PELONDE-ERIMEE; Phone Number: 0596592697; Email: veronique.pelonde-erimee@chu-martinique.fr

Study Locations

• Martinique
  • Fort-de-france, Martinique
    • Recruiting
    • Martinique University Hospital Center
    • Contact: Ornella Dr CABRAS

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 9 years to 17 years (Child)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

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 who Need to take a blood sample or place a peripheral venous line for the management of the child

Collection of the parent's or legal guardian's non-objection to participate in the Dengvaxia® vaccine acceptability survey

Description

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

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dengue seroprevalence in the study population	Number of anti-DENV IgG positive cases, with seroneutralization in favor of previous DENV infection, divided by the total number of 9-17 year odl children/adolescents included in the DengueSEA study	through study completion, an average of 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of primary dengue fever	Serum neutralisation with antibody titration by DENV serotype (DENV 1 to 4)	through study completion, an average of 1 year
Temporal variation of the risk of dengue infection	Implementation of a mathematical prediction model, based on a dynamic mode of infection during dengue epidemics in the French Caribbean, and taking into account dengue seroprevalence and surveillance data in the region since 2001 (Public Health France, sentinel physicians network)	through study completion, an average of 1 year
Seroprevalence of Zika infection	anti-ZIKV IgG positivity and seroneutralization in favor of a previous Zika virus infection divided by the total number of children included in the DengueSEA study	through study completion, an average of 1 year
Assessment of Dengue vaccine acceptability/characterization of intentions and attitudes	Questionnaire developed using the "3C" model developed by the WHO SAGE group to predict the degree of vaccine hesitancy, i.e., the refusal or postponement of certain vaccinations despite the availability of these products. The factors favored by this model are confidence in the safety of the vaccine (Confidence), perception of the importance of the targeted vaccination (Complacency), and perceived difficulties in obtaining this vaccination (Convenience).	through study completion, an average of 1 year

Collaborators and Investigators

• Sponsor: University Hospital Center of Martinique
• Collaborators: Aix Marseille Université; Observatoire Regional de la Sante Provence-Alpes-Côte d'Azur; Ecole des Hautes Etudes en Santé Publique; Institut de Recherche en Santé Publique, France; University Hospital Center of Guadeloupe; Modélisation Mathématique des Maladies Infectieuses UMR 2000, Institut Pasteur
• Investigators: Principal Investigator: Andre CABIE, Martinique University Hospital Center

Study record dates

Study Major Dates

• Study Start (Actual): June 3, 2021
• Primary Completion (Estimated): December 1, 2025
• Study Completion (Estimated): February 1, 2026

Study Registration Dates

• First Submitted: March 29, 2021
• First Submitted That Met QC Criteria: April 7, 2021
• First Posted (Actual): April 9, 2021

Study Record Updates

• Last Update Posted (Actual): January 12, 2024
• Last Update Submitted That Met QC Criteria: January 11, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: children; adolescents; dengue; seroprevalence; vaccination strategy; French Carribean
• Additional Relevant MeSH Terms: Pathologic Processes; RNA Virus Infections; Virus Diseases; Disease Attributes; Arbovirus Infections; Vector Borne Diseases; Flavivirus Infections; Flaviviridae Infections; Hemorrhagic Fevers, Viral; Infections; Communicable Diseases; Dengue
• Other Study ID Numbers: 19_RIPH3_19; 2019-A02114-53 (Other Identifier: Numéro ID RCB _ ANSM)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No