Talk:Dengvaxia controversy

Decontextualized numbers

"One thousand hospitalized"... but over what time period, and how does that compare to normal? PMID 27601519 (from just before the vaccine effort) says that ~842,000 cases of dengue happen each year there, and PMID 28093542 says ~794,000. With those numbers, it seems like only "one thousand hospitalized" could be a significant improvement. Do we have any sources that run proper comparisons? WhatamIdoing (talk) 18:33, 3 January 2019 (UTC)

I'm fairly confident that at this time, there are no MEDRS compliant sources that make such a comparison. So of course my own calculations don't belong in the article, but I did estimate this, digging into the papers you linked, also some papers they cited themselves. Summary, the childhood rate of dengue infection is about 2.5X the overall rate, out of a million kids you'd expect 10-20,000 infections, anywhere from 1500-4000 hospitalizations, and 10-20 deaths. That's just dengue. I also looked up gross mortality data from the Actuarial Society of the Philippines, which gave the all-cause death rate for children under 10 at about 1 per 4000. I haven't seen any sources on what the official cause of death was for the 100+ alleged dead victims (only the two who were confirmed to have died from dengue), but if that's just all or some of the kids who died since the vaccines were given, regardless of cause, that number is not unusual. Of course, in reality there are a shit-ton of variables that need to be accounted for, and hopefully something will appear in the literature that does just that.

There are a lot of recent publicans regarding Dengvaxia, but they don't consider recent clinical evidence from the Philippines, perhaps because that is not yet available. Leaving that aside, some useful sources I did find, PMID 6214489, "Considering dengue infection rates reach up to 90% in Philippines, majority of the school children who were inoculated with Dengvaxia will get the protective benefits of the vaccine. This projection, however, means that at least 10% or around 80 000 of those children who do not have a prior history of dengue infection are now at an increased risk of developing severe dengue", and PMID 29180056, for "hospitalization for severe dengue fever... in children younger than 9 years, the relative risk was 8.5". So this would suggest that you actually might not even notice the harm, if the harm is what would be expected from existing clinical data (the expected number of hospitalizations prevented and the expected number added nearly balance out, depending on vaccine effectiveness rate). Since the vast majority of dengue infections in the Philippines are not reported, it is likely unknowable for most of the vaccine recipients whether they had prior exposure, which would make the requisite subgroup analysis impossible. Someguy1221 (talk) 01:44, 22 January 2019 (UTC)

CRIMINAL CASE ON DENGVAXIA

Total Dengvaxia vaccinated done from March 2016 to November 2017 is 850,000.

Under PNoy –April, May & June 2016, while under President Duterte June 2016 to November 2017.

If this is correct, more children were vaccinated during President Duterte administration.

1. Why was only PNoy charge with criminal case and not President Duterte on this Dengvaxia vaccine case? 2. What countries in the whole world officially accept/allow Dengvaxia by the government? 3. Does Dengvaxia prove to be the cause of death of dengue?

REALME28 (talk) 05:10, 7 February 2019 (UTC)

Dates

Several sections of the article contain dates (e.g. February 5) with no year. This is likely to lead to confusion. Mock wurzel soup (talk) 23:26, 21 June 2019 (UTC)

"600 deaths"

New to wikipedia so not sure how to add to talk pages but:

Spurious interpretation of the text concerning "600 deaths". The statement was that 600 deaths were under investigation, this does not equate to the number of deaths that are caused by DENV. Thanks — Preceding unsigned comment added by 129.96.83.110 (talk) 00:35, 5 February 2020 (UTC)

"600 deaths" is not supported by any credible agency or health provider. the DOH has not linked a single death to the vaccine. — Preceding unsigned comment added by 112.204.230.44 (talk) 05:24, 19 February 2020 (UTC)

Scientific Background - antibody-dependent enhancement

The Wikipedia pages for Dengvaxia controversy and Dengvaxia avoid talking about antibody enhanced disease, which is discussed without talking about vaccines on the Antibody-dependent enhancement page. It would be nice if Wikipedia could approach an expert about adding sections to each of these pages that summarizes how antibody enhanced disease is an important consideration in the safety profile of a vaccine. These pages should link to the Antibody-dependent enhancement page, since it may be important for people to understand when we start discussing the safety of COVID vaccines.

On the Dengue fever page it is discussed how a patient who is exposed to Dengue virus often gets a mild case, and only gets severe disease when they are then exposed to a different serotype of Dengue virus months or years later. But there is a limited understanding about the mechanism by which having immunity to one Dengue serotype enhances the infection from another serotype.

It was known that severe Dengue fever is an antibody enhanced disease when Dengvaxia was developed. The problem with antibody enhanced diseases is that they can be host species specific, so there are not good animal models of these kinds of second infection enhancements. It was thought that Dengvaxia would not cause antibody enhanced disease because 4 different serotypes were included in the vaccine, so the patient would be protected as though they had been exposed to each serotype first.

When the Dengvaxia controversy article discusses how people who were vaccinated died, but not necessarily from the vaccine, that's because these people didn't die when they were vaccinated. Instead, they mostly died from Dengue fever that developed from their first exposure to Dengue virus after they were vaccinated. The vaccine only failed for the people who had never been exposed to Dengue virus before their inoculation. For people who had previously had a mild case of Dengue fever, the vaccine prevented them from developing severe Dengue fever when they were exposed after their vaccination. But the people who died probably would not have died from their first exposure to Dengue virus if they had not been vaccinated.

This episode is an example of how hard it is to properly safety test a vaccine for a disease that can be worse the second time you get it. The standard safety testing focuses directly on whether the vaccine causes immediate harm, and ends before there is enough exposure to tell whether the vaccine can act like a first infection and cause antibody enhanced disease when the patient is exposed to the natural virus the first time, which could be months or years after the vaccination. Since coronaviruses might also be antibody enhanced diseases, and that might affect the safety of vaccines that are under development, it would be nice if these Dengue related Wikipedia pages were updated to include a discussion of how Dengvaxia failed to protect naïve patients from severe disease, when it did not show an issue in the safety testing stage, and did prevent severe disease in experienced patients. PRR-Concord (talk) 09:08, 7 September 2020 (UTC)

removal of referenced material

I've again reverted the removal of referenced material from this article. The claim was raised that the referenced article "doesn't explicitly say that the vaccine saving lives is Dengvaxia", but in fact it does. I've moved a quote from the article into the reference given here.

Maybe that source isn't particularly reliable, but removing the reference definition leaves the the reference definition ":1" undefined, which raises an error in the rendering of the article. If this reference must be removed (can we explain why?) then that usage of the reference must be examined and perhaps replaced, either ... but leaving the article with visible referencing errors is unacceptable. -- Mikeblas (talk) 16:41, 17 February 2021 (UTC)

Aftermath

This section says "Most of the concerns about the dangers of the vaccine were imagined rather than based on fact.[2]"--is this claim substantiated by that source? I think the below paragraph is where this comes from, but it seems taken out of context. The point of the source is that prior to this crisis most concerns about vaccines (in general) were based on rumors and not facts. But in the case of this crisis (and this particular vaccine), the concerns were based on results from clinical trials.

• “Vaccine hesitancy” refers to delay in acceptance or refusal of safe vaccines despite the availability of vaccination services. Even today, 1 in 5 children worldwide fail to receive routine immunization, and about 1.5 million children die each year of diseases that could be prevented by vaccination [8]. Concern over vaccine safety is one of the most dominant reasons for vaccine hesitancy. Earlier, these concerns were mainly due to widely circulating media reports highlighting a rare occurrence of an adverse reaction to a vaccine, or associating certain disorders to vaccines or their components [9]. Most of these concerns, however, were based on rumors rather than the facts and yet somehow managed to instill fear in the hearts and minds of parents. Unfortunately, the crisis that we are dealing with now is based on results from clinical trials backed up by autopsies linking some deaths to Dengvaxia [6]. These findings may serve as proof against vaccine safety and might have a negative impact on other vaccination programs. With the news being widely circulated through media, this would not just affect Philippines but also other parts of the world.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214489/

2600:1700:6270:CA0:8050:72F1:42AD:2A93 (talk) 15:35, 6 April 2021 (UTC)

It's not 100% clear but I think you're right. It would probably be better to say something like "the dengvaxia controversy has further contributed to vaccine hesitancy in the Philippines, by amplifying largely irrational fears about vaccine safety with what could be taken as confirmatory evidence about the harmfulness of vaccines in general" ? Alexbrn (talk) 15:49, 6 April 2021 (UTC)

What about "The Dengvaxia controversy contributed to overall vaccine hesitancy due to concern about vaccine safety in the Philippines. While concerns about vaccine safety in the case of Dengvaxia were based on results from clinical trials, concerns about the safety of other vaccines are based on rumors rather than facts."? 2600:1700:6270:CA0:6855:CCC7:754E:A3A (talk) 18:50, 8 April 2021 (UTC)

The problem is that implies every concern about Dengvaxia was entirely rational. Alexbrn (talk) 19:32, 8 April 2021 (UTC)

Maybe "The Dengvaxia controversy contributed to overall vaccine hesitancy due to concern about vaccine safety in the Philippines. While some concerns about vaccine safety in the case of Dengvaxia were based on results from clinical trials, most concerns about vaccine safety are based on rumors rather than facts." I don't think this has the same implication and seems to more faithfully represent the information from the source. 2600:1700:6270:CA0:858:4DBC:B351:10F2 (talk) 20:39, 9 April 2021 (UTC)

That's good - but to avoid WP:CLOP a bit more condensing gives "In the Philippines, The Dengvaxia controversy has contributed to overall vaccine hesitancy because of heightened concerns about vaccine safety. While concerns about vaccine safety are usually irrational, in the case of Dengvaxia there was a basis in evidence." ? Alexbrn (talk) 04:35, 10 April 2021 (UTC)

That sounds good. 2600:1700:6270:CA0:2990:30DE:F1E2:7762 (talk) 16:07, 10 April 2021 (UTC)

Done. Alexbrn (talk) 16:12, 10 April 2021 (UTC)

Scientific American

The Scientif American has a blonger background article on it, which possibly can be used to replace some of the current news media sources:

• https://www.scientificamerican.com/article/how-the-worlds-first-dengue-vaccination-drive-ended-in-disaster/

--Kmhkmh (talk) 13:03, 17 March 2023 (UTC)