Bhatt, S. et al. The global distribution and burden of dengue. Nature 496504–507 (2013).
Google Scholar
Stanaway, J. D. et al. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect. Dis. 16712–723 (2016).
Google Scholar
Yang, X., Quam, M. B. M., Zhang, T. & Sang, S. Global burden for dengue and the evolving pattern in the past 30 years. J. Travel Med. 28taab146 (2021).
Google Scholar
Halstead, S. B. Pathogenesis of dengue: challenges to molecular biology. Science 239476–481 (1988).
Google Scholar
Katzelnick, L. C. et al. Antibody-dependent enhancement of severe dengue disease in humans. Science 358929–932 (2017).
Google Scholar
Capeding, M. R. et al. Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial. Lancet 3841358–1365 (2014).
Google Scholar
Villar, L. et al. Efficacy of a tetravalent dengue vaccine in children in Latin America. N. Engl. J. Med. 372113–123 (2015).
Google Scholar
Sridhar, S. et al. Effect of dengue serostatus on dengue vaccine safety and efficacy. N. Engl. J. Med. 379327–340 (2018).
Google Scholar
Hadinegoro, S. R. et al. Efficacy and long-term safety of a dengue vaccine in regions of endemic disease. N. Engl. J. Med. 3731195–1206 (2015).
Google Scholar
World Health Organization Dengue vaccine: WHO position paper, September 2018—recommendations. Vaccine 374848–4849 (2019).
Biswal, S. et al. Efficacy of a tetravalent dengue vaccine in healthy children and adolescents. N. Engl. J. Med. 3812009–2019 (2019).
Google Scholar
Tricou, V. et al. Long-term efficacy and safety of a tetravalent dengue vaccine (TAK-003): 4.5-year results from a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Glob. Health 12e257–e270 (2024).
Google Scholar
World Health Organization Meeting of the Strategic Advisory Group of Experts on Immunization, September 2023: conclusions and recommendations. Wkly Epidemiol. Rec. 98599–620 (2023).
Blaney, J. E. Jr., Durbin, A. P., Murphy, B. R. & Whitehead, S. S. Development of a live attenuated dengue virus vaccine using reverse genetics. Viral Immunol. 1910–32 (2006).
Google Scholar
Kallas, E. G. et al. Safety and immunogenicity of the tetravalent, live-attenuated dengue vaccine Butantan-DV in adults in Brazil: a two-step, double-blind, randomised placebo-controlled phase 2 trial. Lancet Infect. Dis. 20839–850 (2020).
Google Scholar
Kallas, E. G. et al. Live, attenuated, tetravalent Butantan-dengue vaccine in children and adults. N. Engl. J. Med. 390397–408 (2024).
Google Scholar
Nogueira, M. L. et al. Efficacy and safety of Butantan-DV in participants aged 2–59 years through an extended follow-up: results from a double-blind, randomised, placebo-controlled, phase 3, multicentre trial in Brazil. Lancet Infect. Dis. 241234–1244 (2024).
Google Scholar
Brazil. Ministry of Health, Health Surveillance Secretariat. Dengue: diagnosis and clinical management: adults and children. Technical Management Directorate 4th edn (in Portuguese) (2013).
Glasner, D. R., Puerta-Guardo, H., Beatty, P. R. & Harris, E. The good, the bad, and the shocking: the multiple roles of dengue virus nonstructural protein 1 in protection and pathogenesis. Annu. Rev. Virol. 5227–253 (2018).
Google Scholar
Vannice, K. S. et al. Clinical development and regulatory points for consideration for second-generation live attenuated dengue vaccines. Vaccine 363411–3417 (2018).
Google Scholar
Brazil, Ministry of Health, Health Surveillance Secretariat. Monitoring of arboviruses and closing balance of the Emergency Operations Committee (COE) Dengue and other Arboviruses 2024. Epidemiological Bulletin 5511 (in Portugese) (2025).
Nivarthi, U. K. et al. A tetravalent live attenuated dengue virus vaccine stimulates balanced immunity to multiple serotypes in humans. Nat. Common. 121102 (2021).
Google Scholar
Russell, K. L. et al. A phase I randomized, double-blind, placebo-controlled study to evaluate the safety, tolerability, and immunogenicity of a live-attenuated quadrivalent dengue vaccine in flavivirus-naive and flavivirus-experienced healthy adults. Hum. Vaccin. Immunother. 182046960 (2022).
Google Scholar
Whitehead, S. S. et al. In a randomized trial, the live attenuated tetravalent dengue vaccine TV003 is well-tolerated and highly immunogenic in subjects with flavivirus exposure prior to vaccination. PLoS Negl. Too much. Say. 11e0005584 (2017).
Google Scholar
Durbin, A. P. et al. A 12-month-interval dosing study in adults indicates that a single dose of the National Institute of Allergy and Infectious Diseases tetravalent dengue vaccine induces a robust neutralizing antibody response. J. Infect. Dis. 214832–835 (2016).
Google Scholar
Faria, N. R. et al. Zika virus in the Americas: early epidemiological and genetic findings. Science 352345–349 (2016).
Google Scholar
Fields, GS, Bandeira, AC & Sardi, SI Zika virus outbreak, Bahia, Brazil. Emerg. Infect. Dis. 211885–1886 (2015).
Google Scholar
Zambrana, J. V. et al. Primary exposure to Zika virus is linked with increased risk of symptomatic dengue virus infection with serotypes 2, 3, and 4, but not 1. Sci. Transl. Med. 16eadn2199 (2024).
Google Scholar
Estofolete, C. F. et al. Influence of previous Zika virus infection on acute dengue episode. PLoS Negl. Too much. Say. 17e0011710 (2023).
Google Scholar
Nunes, K. et al. Admixture’s impact on Brazilian population evolution and health. Science 388eadl3564 (2025).
Google Scholar
Whiteman, M. C. et al. Virus reduction neutralization test: a single-cell imaging high-throughput virus neutralization assay for dengue. Am. J. Trop. Med. Hyg. 991430–1439 (2018).
Google Scholar
Johnson, B. W., Russell, B. J. & Lanciotti, R. S. Serotype-specific detection of dengue viruses in a fourplex real-time reverse transcriptase PCR assay. J. Clin. Microbiol. 434977–4983 (2005).
Google Scholar
World Health Organization. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control new edn. (World Health Organization, 2009).
Blackwelder, W. C. Sample size and power for prospective analysis of relative risk. State. With. 12691–698 (1993).
Google Scholar
Beran, J. et al. Challenge of conducting a placebo-controlled randomized efficacy study for influenza vaccine in a season with low attack rate and a mismatched vaccine B strain: a concrete example. BMC Infect. Dis. 92 (2009).
Google Scholar
Bhandari, N. et al. Efficacy of a monovalent human-bovine (116E) rotavirus vaccine in Indian infants: a randomised, double-blind, placebo-controlled trial. Lancet 3832136–2143 (2014).
Google Scholar
Brown, L. D., Cai, T. T. & DasGupta, A. Interval estimation for a binomial proportion. Stat. Sci. 16101–117 (2001).
Google Scholar
Chan, I. S. F. & Bohidar, N. R. Exact power and sample size for vaccine efficacy studies. Commun Stat.-Theor M. 271305–1322 (1998).
Google Scholar
Blaker, H. Confidence curves and improved exact confidence intervals for discrete distributions. Can. J. Stat. 28783–798 (2000).
Google Scholar
