ACIP recommends a 3-dose Dengvaxia vaccine schedule, with doses administered at 0, 6 months, and 12 months.
Ask the Experts: Dengue: Scheduling & Administration
The recommended interval is 6 calendar months between each dose, and the minimum interval is 5 calendar months between each dose. In accordance with CDC’s general best practice guidelines, a dose administered up to 4 days before the minimum interval may be counted as valid. If a dose is given too early, the recommendation is to repeat the dose at the minimum interval of 5 months.
Dengvaxia is administered as a 3-dose series, spaced 6 months apart (0, 6, and 12 months). Each dose is 0.5 mL in volume, administered subcutaneously. The vaccine comes in powder form (lyophilized) in single dose vials. Each lyophilized vaccine vial should be mixed with the supplied diluent, a vial of saline diluent (0.4% NaCl). To reconstitute Dengvaxia, withdraw 0.6 ml from the diluent vial and inject it into the lyophilized vaccine vial. Swirl the vial gently. After reconstitution, the suspension is colorless and may develop trace amounts of white to translucent particles.
After reconstitution, 0.5 mL of Dengvaxia should be withdrawn and immediately administered subcutaneously. If not used immediately, the reconstituted vaccine should be refrigerated at 36°F–46°F (2°C–8°C) and used within 30 minutes. Do not use the vaccine more than 30 minutes after reconstitution.
Dengvaxia is for subcutaneous use only. Dengvaxia should not be administered by intramuscular injection; however, if administered intramuscularly in error, the dose does not need to be repeated.
CDC has a web page dedicated to the storage and reconstitution of Dengvaxia: www.cdc.gov/dengue/vaccine/hcp/storage-handling.html.
No, the dose should not be repeated. In accordance with CDC’s “General Best Practice Guidelines for Immunization”, the immune response to vaccines recommended to be administered by the subcutaneous route is unlikely to be affected if the vaccines are inadvertently administered by the intramuscular route. For this reason, repeating doses of vaccine administered by the intramuscular route when recommended by the subcutaneous route is not necessary (www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html).
Yes, Dengvaxia may be given at the same visit with any live or non-live vaccines that are also indicated for the patient.
If Dengvaxia is not administered on the same day as another live vaccine, the two vaccines should be separated by at least 4 weeks to minimize the potential risk of interference.
You should continue where the patient left off and complete the series. You never have to restart the series.
Yes. You must initiate the series while the recipient is age 16 years, but you may complete the series even if the recipient turns 17 before the series is completed.
The parent/caregiver should be notified immediately, warned of the possible increased risk for hospitalization and severe dengue if the person develops a subsequent natural dengue infection, and the need to seek immediate medical attention if warning signs of severe dengue develop.
Clinic staff should review the incident and ensure that staff members responsible for vaccination have had sufficient training and protocols are in place to prevent such errors.
The use of tools, such as the CDC prevaccination checklist, helps prevent such errors: (www.cdc.gov/dengue/resources/DVBD_FS_Vaccination_Checklist-508.pdf).
Children and adolescents who have been diagnosed with acute dengue should wait at least 6 months after the date the dengue illness is confirmed to begin the vaccine series.