Shared evidence, different recommendations: a comparative analysis of Qdenga (TAK-003) dengue vaccine guidance for travellers across countries

Journal of Travel Medicine, vol. 33

Abstract

INTRODUCTION: Dengue is an increasingly important cause of illness in travellers, and Qdenga (TAK-003) is the first dengue vaccine incorporated into guidance for travellers in multiple countries. However, clinicians and travellers may encounter differing recommendations across jurisdictions. This study compared guidance on the use of Qdenga in travellers across countries. METHODS: We conducted a comparative analysis of national guidance on Qdenga use for travellers across countries, using survey data and structured review of publicly available recommendations. Guidance was synthesized according to dengue immune status and mapped across recurring decision domains. RESULTS: Survey responses were obtained from 18 advisory bodies across 17 countries between March and April 2026, including 12 non-endemic countries where Qdenga was licensed and guidance published. Guidance was generally more restrictive than regulatory authorization. While there was broad agreement in recommending vaccination for travellers with laboratory-confirmed prior dengue infection, recommendations for those without documented infection varied widely. All advisory bodies considered destination-specific dengue risk but differed in whether and how they used travel duration, repeated or cumulative exposure, traveller characteristics and host susceptibility factors to determine vaccine eligibility. Some recommendations restricted vaccination to travellers with prior dengue infection, whereas others extended eligibility to selected travellers without documented prior infection or recommended vaccination based on exposure risk, irrespective of serostatus. Approaches also differed in assessment of prior dengue infection and whether completion of the two-dose series before travel was required. CONCLUSIONS: Variation in Qdenga guidance reflects differences in how advisory bodies interpret shared evidence and manage uncertainty arising from data gaps and differences between trial populations and travellers. Additional data on vaccine effectiveness and clinical outcomes among seronegative travellers and older adults may help reduce uncertainty and support greater alignment of future recommendations. Regardless, transparency and shared clinical decision-making remain essential when discussing dengue vaccination with travellers.

Authors 8

1. Sarah L. McGuinness

   The Alfred Hospital · Monash University

   Affiliation as printed

   Department of Infectious Diseases, The Alfred and School of Translational Medicine, Monash University , 55 Commercial Road, Melbourne, VIC 3004 ,

   School of Public Health and Preventive Medicine, Monash University , 553 St Kilda Road, Melbourne, VIC, 3004  

2. Dipti Patel

   University College Hospital · University College London Hospitals NHS Foundation Trust · University College London

   Affiliation as printed

   National Travel Health Network and Centre (NaTHNaC), University College London Hospitals , 250 Euston Road, London NW1 2PG ,

3. Helena Hervius Askling

   Karolinska Institutet · Stockholm Health Care Services

   Affiliation as printed

   Academic Specialist Centre, Stockholm Health Care Services , Solnavägen 1E, 113 65 Stockholm ,

   Department of Medicine, Division of Infectious Diseases, Karolinska Institutet , K2 Medicin, Solna 171 77 Stockholm ,

4. Camilla Rothe

   LMU Klinikum · Institut für Infektions- und Tropenmedizin · Ludwig-Maximilians-Universität München

   Affiliation as printed

   Institute of Infectious Diseases and Tropical Medicine, LMU University Hospital , 80802 Munich, Bavaria ,

5. Steven Schofield

   Department of National Defence · Government of Canada

   Affiliation as printed

   Department of National Defence , Government of Canada, 101 Colonel By Drive, Ottawa, ON K1A 0K2 ,

6. Robert J. Steffen

   University of Zurich

   Affiliation as printed

   Division of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health , University of Texas, 7000 Fannin, Houston, TX 77030 ,

   Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, WHO Collaborating Centre for Travelers’ Health, University of Zurich , Hirschengraben 84, CH-8001, Zurich ,

7. Leo G. Visser Aachen Department of Infectious Diseases

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Dutch Coordination Centre for Travellers Health Advice , 1018 WT Amsterdam ,

   Leiden University Centre for Infectious Diseases, Department of Infectious Diseases, Leiden University Medical Centre , 2333 Leiden ,

8. Lin Hwei Chen

   Mount Auburn Hospital · Harvard University

   Affiliation as printed

   Department of Medicine, Mount Auburn Hospital , 330 Mount Auburn Street, Cambridge, MA 02138 ,

   Faculty of Medicine, Harvard Medical School , 25 Shattuck Street, Boston, MA 02115 ,