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Dengue Infections Soar Globally While Prevention And Treatment Options Fade
People comfort their children suffering from dengue fever at a government hospital in Dhaka on ... [+] October 19, 2022. (Photo by Munir uz ZAMAN / AFP) (Photo by MUNIR UZ ZAMAN/AFP via Getty Images)
AFP via Getty ImagesDengue is a miserable illness caused by infection with any of the four dengue viruses (dengue-1, -2, -3 and -4). Infections have increased dramatically over the past two years while, at the same time, developers of anti-dengue drugs and vaccines have abandoned their research and development efforts. As a result, public health officials and clinicians are becoming increasingly concerned about their limited options to keep their populations and patients safe.
The Dengue Problem is WorseningThe dengue viruses primarily circulate in the tropics and subtropics and are transmitted to people by infected mosquitoes. There are an estimated 400 million infections every year making about 100 million people ill. Many recovering patients have told me dengue made them feel so sick they thought they were going to die. Annual dengue fatalities range between 8,000 and 40,000 people per year, with many deaths occurring in children.
Once infected with a specific dengue virus, the individual will develop immunity against that virus and be protected from future illnesses for years. However, a person can always be infected a second time with a different dengue virus. It is these second infections where the risk of severe dengue and death is highest. Third or fourth infections usually do not make people very ill because of the immunity developed from the first two infections.
Beginning in 2023, the global dengue problem started to significantly worsen. Dengue cases skyrocketed around the world not only in locations known to be endemic for the viruses like Central and South America and Southeast Asia, but also in new locations such as Nepal and Bangladesh. Infections this year alone are more than 300% higher in the Caribbean and Americas compared to the average of the last five years. Cases have also started popping up in more temperate climates. France had more locally acquired dengue virus infections in 2024 than any year prior.
In 2023 and 2024, the U.S. Experienced an increase in the number of people becoming infected while traveling (4,730). There was also a rise in locally acquired dengue infections in places like Florida (249), Texas (2) and California (17). Puerto Rico frequently has dengue outbreaks and experienced a rise in infections with 6,452 reported cases.
Where Are the Anti-Dengue Vaccines and Drugs?At the same time infections are surging, vaccine and drug developers have started calling it quits in the fight against dengue. Sanofi had one of only two licensed dengue vaccines, Dengvaxia, and the only vaccine licensed in the United States. The company recently announced it will stop manufacturing Dengvaxia, and existing supplies will fade away by August 2026. The company cited low global demand as the reason for discontinuing a vaccine, which took over two decades and cost more than $1.5 billion dollars to develop.
The other licensed dengue vaccine, TAK-003, is made by the Japanese vaccine developer Takeda. Although TAK-003 is a modest improvement over Sanofi's vaccine, it, too, has significant limitations. The vaccine has a better safety profile than Dengvaxia, but it does not seem to work against the dengue-3 virus, only the dengue-1 and dengue-2 viruses. It is unclear if works against dengue-4.
Millions of TAK-003 vaccine doses were provided to countries in Latin America during the recent dengue surge, and observations on safety and effectiveness from real world use will be available in the coming years. The U.S. May or may not benefit from this data because the company pulled out of the Food and Drug Administration review process required for vaccine licensure. It remains to be seen whether Takeda will reengage with the FDA and if TAK-003 will ever be available in the United States.
Janssen, a company of Johnson & Johnson, has also recently thrown in the towel in the fight against dengue. The company announced that it will cease development of Mosnodenvir, a drug candidate designed to be the first anti-viral treatment for dengue. It is unclear if another developer will license the drug and continue its development. As with Dengvaxia, Janssen's decision represents years of lost effort and millions of dollars. (Disclosure: Throughout my career I have consulted with anti-dengue vaccine and drug developers including Sanofi, Takeda, Janssen and Merck.)
Are We Losing the Dengue War?There are plenty of reasons to be pessimistic about our ability to confront the global dengue problem and prevent its further expansion into the United States.
Changing temperature and rainfall patterns have allowed the mosquito species that transmit dengue to flourish in the U.S. And extend to areas where they were not seen previously. This is a similar trend to what is being observed for diseases transmitted by ticks.
A second reason for concern is that every year more than 15 million travelers enter the U.S. From areas where dengue viruses circulate. More than 30 million Americans travel to and return from similar areas. Every traveler has the potential to introduce a dengue virus into the country.
More dengue viruses and more mosquitoes capable of transmitting them does not bode well for populations like the U.S., where most people lack immunity to any of the four dengue viruses.
Air-conditioning, indoor plumbing and window screens can limit high intensity human and mosquito interactions lowering the likelihood the U.S. Will experience major dengue epidemics similar to those in Latin America and Southeast Asia. However, smaller local outbreaks like those in Key West, Florida (2009-2010), and Hawaii (2015-2016) remain possible and would stress local health care systems and cost millions of dollars to manage.
Another potential bright spot is that some scientists continue to develop anti-dengue vaccine and drug candidates. There is also interest in using newer antibody infusion technologies, like what was used to treat COVID-19 patients, to prevent or treat dengue virus infections. Antibody preparations could provide short-term protection from dengue during outbreaks or as a treatment for people already infected.
The Serum Institute of India is field testing an antibody preparation designed to treat dengue virus-infected patients. The antibodies are supposed to interrupt the virus' multiplication in the body, thereby reducing the severity of illness patients experience. Academic groups and U.S. Government agencies are also exploring the use of manufactured anti-dengue antibodies.
On the vaccine front, the Instituto Butantan (Brazil) licensed dengue vaccine technology from the U.S. National Institutes of Health and have completed a large (~16,000 people) field trial testing their vaccine formulation (Butantan-DV). The vaccine appears well tolerated and prevents a significant proportion of dengue-1 and dengue-2 illnesses. The company announced it has provided Brazilian regulators (Anvisa) all the final documentation required for them make a determination on whether the vaccine can be registered and made available in Brazil.
Panacea Biotech in India licensed the same NIH materials and started a large-scale vaccine field trial in 2024. Merck (MSD) is another licensee and is also expected to launch field trials. If the vaccine is successful and MSD pursues a license in the U.S., access remains years away.
What About the Future of Dengue Research?Even though academic, government and industry groups are working on developing dengue prevention and treatment options now, there is a real risk that the resources supporting this work could soon dry up.
For over a century, the U.S. Government has played an important role in advancing dengue research through work in the Department of Defense, Centers for Disease Control and Prevention and the NIH. The government has also influenced scientific advancement through its various external funding mechanisms. These activities have incentivized industry to take on the financial and scientific risk associated with developing vaccines and drug candidates where the market for the final products is unpredictable. The shared risk approach has been productive.
Depending on who Congress confirms to lead the U.S. Health and Human Services and its family of subordinate agencies, infectious diseases research could be significantly de-prioritized and underresourced in both money and human capital. This would certainly limit the U.S. Government's footprint in the dengue research landscape, but also dissuade other entities from starting or continuing their dengue work. All of this would be bad news for countries like the U.S., which are almost certainly going to confront a worsening dengue problem but currently have few tools at their disposal to prevent or manage the infections.
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Complementary Treatments For Hepatitis C
If you're looking for ways to treat hepatitis C, you have more choices than ever before, including antiviral medicines that cure the disease (the first-line treatment for hep C). But some people turn to complementary treatments to help relieve symptoms or because their current medicine isn't working for them.
Before you try any complementary or alternative treatment, like herbal remedies, ask your doctor if it's safe. And be sure to find out what dose to take.
Some studies show a few herbal remedies may have promise against hepatitis C, but so far none of them has been proven to work. And some alternative treatments can lead to liver damage or cause problems with other drugs you take.
SilymarinThis extract of the milk thistle plant is the most popular herbal remedy for hepatitis C. Some people use it to bring down inflammation and remove toxins from the liver.
In animal and cell studies, silymarin blocked the hepatitis C virus and protected the liver from damage. But research in people hasn't been as positive. In one study of nearly 400 people with hepatitis C, it didn't improve liver function or reduce levels of the virus.
How you take silymarin could matter. There's some evidence that it has antiviral effects when a doctor puts it in your vein with an IV.
Side effects of silymarin are usually mild, such as:
It contains antioxidants called catechins that may help protect liver cells from damage. Some of these catechins may help block the hepatitis C virus from infecting the liver and help prevent liver cancer.
Drinking green tea in moderation appears to be safe, but there have been reports of liver damage in people who took supplements. Green tea extract is an ingredient in many popular weight loss products, some of which have been linked to liver failure.
NaringeninThis natural compound gives grapefruit its bitter taste. It may work to help reduce inflammation.
In lab studies, naringenin helped block the hepatitis C virus from infecting new cells. Whether it's a useful treatment for hepatitis C is still not clear.
GlycyrrhizinThis licorice root extract has been part of Chinese and Middle Eastern medicine for centuries. More recently, it's been studied as a treatment for chronic hepatitis C. Glycyrrhizin has anti-inflammatory and antiviral effects, and it may help protect against liver cancer.
In studies, people took glycyrrhizin through a vein. The licorice root supplements you take by mouth may not be as helpful.
Also, this treatment can cause side effects like high blood pressure, low potassium levels, and an irregular heartbeat. It could be dangerous for people with conditions like heart disease, kidney failure, or diabetes.
Colloidal SilverColloidal silver contains the same metal found in earrings or tableware, only it's suspended in water.
It's been promoted as a hepatitis C treatment, but there's no evidence that it works. It's not a safe alternative. It can cause permanent, serious side effects, including argyria -- a bluish color to your skin, eyes, and organs.
ZincThis element is essential for many bodily functions, including a healthy liver. Zinc levels often drop as your hepatitis C gets worse. Some research suggests zinc supplements might help protect the liver from damage and prevent liver cancer.
Zinc can cause side effects like:
It's common for people with hepatitis C to have low levels of vitamin D in their blood. Along with keeping your bones strong, this vitamin helps your body fight off the virus. People who are low in vitamin D are more likely to have severe liver scarring.
Your doctor can do a blood test to check your vitamin D level. If it's low, taking a supplement can bring it up to normal, though research doesn't show that it helps improve how well standard hepatitis C treatment works.
TurmericThis spice gives curry powder its vibrant yellow color. In supplement form, some people use turmeric to treat a number of health conditions, from arthritis to stomach ailments.
In lab studies, curcumin stopped the hepatitis C virus from copying itself. It might also help clear toxins from the liver. More research is needed to confirm whether it's useful as a treatment for hepatitis C.
GinsengSome studies suggest this herb protects the liver against the effects of disease and injury. But there is some serious concern about its safety for your liver.
One worry is that ginseng could damage the liver if you take it at the same time as certain other medicines, such as:
Before you use ginseng, discuss it with your doctor and go over your whole list of medications with them.
Herbal Remedies to AvoidSome herbal supplements are dangerous for people with hepatitis C because they cause liver damage. These include:
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