Clinical impact of childhood and adolescence dengue vaccination in Indonesia: A dynamic transmission modeling study

Indonesia is estimated to be among the countries with the highest dengue disease burden in the world. Multiple mathematical models have investigated the potential public health and economic impacts of dengue vaccination in Indonesia. However, many of these models either omitted transmission dynamics or overlooked some key aspects of dengue transmission. This study aimed to assess the potential impact of a hypothetical vaccine in Indonesia using a transmission model that accounts for key features known to affect the transmission dynamics of dengue. Across 122,472 scenarios related to vaccine's profile (efficacy, and duration of efficacy) and implementation strategies (vaccination coverage rate, and targeted age of vaccination), we evaluated the potential impact of routine dengue vaccination for children and adolescents (ages 1 - 18 years) and identified the optimal target age of vaccination to avert the maximum number of symptomatic cases. Across scenarios, vaccinating 1- or 2-year-olds averted the largest proportion of symptomatic cases (3.47%-55.00%, depending on vaccine profile), whereas vaccinating 10-18-year-olds averted the fewest (2.25%-47.50%). We estimated that the median (95% uncertainty interval; UI) number of symptomatic dengue cases prevented by vaccination over a 20-year horizon following vaccine introduction ranged from 4.9 (95% UI: 1.6-13.6) million to 8.6 (95% UI: 3.5-16.7) million. These findings indicate that a safe and effective dengue vaccine for all age groups administered to young children could substantially reduce the dengue burden in Indonesia.