Dengue vaccine !
Live attenuated tetravalent vaccines. WHO recommends TAK-003 for children aged 6–16 in high-transmission settings; CYD-TDV only after a previous infection.
Updated 2026-11-01
Also called: TAK-003 (tetravalent), CYD-TDV (tetravalent)
The figure shows the envelope protein of dengue virus type 2; the vaccines aim to induce neutralising antibodies against the E protein of all four serotypes.
Mechanism of action
There are four dengue serotypes. A second infection with a different serotype carries a higher risk of severe dengue, because non-neutralising antibodies can help the new virus. A vaccine that acts like a first infection in someone never infected could therefore raise risk later: this was seen with CYD-TDV, which is used only in people with proof of a previous infection. TAK-003 protects against all four serotypes in previously infected people, but in seronegative people protection is shown only against DENV-1 and DENV-2, and a risk with DENV-3 and DENV-4 cannot be ruled out.
- Attenuated viruses of the four serotypes are injected
- Neutralising antibodies form against each envelope protein
- Protection is most complete in people previously infected
- In seronegative people, DENV-3 and DENV-4 protection is unproven
Pharmacokinetics
- Onset and duration
- Partial protection after the full series; breakthrough infections can still occur
Indications
- TAK-003: children aged 6–16 in settings with high dengue burden and transmission (WHO) Dengue →
- CYD-TDV: only people with laboratory evidence of a previous dengue infection (pre-vaccination screening) Dengue →
Adverse effects
Common
- Local reactions at the injection site
Contraindications
- Congenital or acquired immunodeficiency, including immunosuppressive therapy
- Symptomatic HIV or HIV with impaired immune function
- Pregnancy and breastfeeding (TAK-003)
- CYD-TDV: no evidence of previous dengue infection
Key interactions
- Immunosuppressive therapy (chemotherapy, high-dose systemic corticosteroids)
- Contraindicated, as with other live attenuated vaccines
- HPV vaccine and Tdap
- CYD-TDV labelling allows them to be given at the same visit
What is monitored
- Serostatus before CYD-TDV
- Dengue warning signs if fever occurs later: the vaccine does not fully prevent disease
Administration and safety
- Follow the product label for route and preparation
- Check which product is used: the eligibility rules of TAK-003 and CYD-TDV differ
- Check pregnancy, breastfeeding and immune status before giving
- Record the batch and product
Nursing care
- Confirm previous dengue infection before CYD-TDV
- Ask about pregnancy, breastfeeding and immunosuppression
- Explain that vaccination does not replace mosquito control or the warning signs of dengue
- Advise avoiding pregnancy for one month after TAK-003
Pregnancy and breastfeeding
TAK-003 is not recommended in pregnancy and pregnancy is avoided for one month afterwards; it is contraindicated during breastfeeding until data are available. Dengue itself raises the risk of pregnancy complications.
Test yourself
Think of the answer, then tap the question to see it.
Why is CYD-TDV restricted to people with a previous dengue infection?
In seronegative people it acts like a first infection and increases the risk of severe dengue at the next natural infection.
In which group and setting does WHO recommend TAK-003?
Children aged 6–16 years in settings with high dengue burden and transmission intensity.
Against which serotypes is TAK-003 protection unproven in seronegative people?
DENV-3 and DENV-4.
Related drugs
Related conditions
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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: WHO position paper on dengue vaccines – May 2024 (World Health Organization, 2024); Dengue (World Health Organization, 2025); WHO prequalifies new dengue vaccine (World Health Organization, 2024); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.