RESUMO
Aim: to conduct a systematic literature review on dengue costs in Latin America, comparing study methodologies, disease costs and the economic impact of dengue in different countries. Methods: the literature search was carried out in the following electronic databases: MEDLINE/ PubMed, EMBASE and LILACS, for the period between 2004 and 2014. To make comparisons possible, the costs identified in the selected studies were converted to local currency values, adjusted to the consumer price index (2014) and converted to purchasing power parity (PPP). Results: 728 publications were identified in databases and 13 papers were selected for analysis. Nine of the thirteen studies were conducted from a societal perspective and three from a health system perspective. In most studies, indirect costs accounted for the largest percentage of total outpatient costs. In contrast, for hospitalized patients, direct medical costs showed the highest percentages. The economic impact of dengue was estimated at I$ 3.2 billion per year, ranging from I$ 1.4 to I$ 5.9 billion, when including the six sub-regions of the Americas. Conclusion: dengue represents a high cost for Latin American society and health system. Studies varied in terms of cost methodology (cost items included, such as direct medical and non-medical and indirect costs, and cost analysis) and the different epidemiological periods in which research was carried out (endemic and/or epidemic).
Assuntos
Dengue , Economia e Organizações de Saúde , Revisão , Custos e Análise de Custo , América LatinaRESUMO
Este artigo é uma revisão sobre o desenvolvimento de uma vacina candidata tetravalente contra a dengue (VTD) composta por 4 cepas recombinantes vivas atenuadas de vírus da dengue. Cada cepa expressa os genes da pré-membrana (prM) e do envelope de um dos quatro sorotipos do vírus da dengue e tem como base a cepa da vacina febre amarela 17D (YF17D). Os estudos pré-clínicos demonstraram que as cepas da VTD são estáveis genética e fenotipicamente, não hepatotrópicas, menos neurovirulentas do que a cepa YF 17D e não infectam mosquitos pela via oral. A VTD induz estimulação controlada das células dendríticas humanas e respostas imunes significantes...
The Sanofi Pasteur tetravalent dengue vaccine candidate is composed of 4 recombinant live attenuated vaccines based on a yellow fever vaccine 17D (YFV 17D) backbone, each expressing the prM and envelope genes of one of the four dengue virus serotypes. Pre-clinical studies have demonstrated that the TV dengue vaccine is genetically and phenotypically stable, non-hepatotropic, less neurovirulent than YFV 17D and does not infect mosquitoes by the oral route. In vitro and in vivo preclinical studies also showed that the TV dengue vaccine induced controlled stimulation in human dendritic cells, and significant immune responses in monkeys. TV dengue vaccine reactogenicity, viraemia induction and antibody responses were investigated in three Phase I trials in the USA, the Philippines and Mexico, in a two or three-dose regimen over a 12 month period...