Elderly people need a prescription to be vaccinated against dengue; understand

The elderly population currently has the highest rates of hospitalization for dengue in Brazil. The group, however, was left out of the age group considered a priority to receive the dengue vaccine through the Unified Health System (SUS). This is because Qdenga’s leaflet itself stipulates that the vaccine is only indicated for people aged between 4 and 60 years. Even so, in private laboratories, the vaccine is administered to the elderly, as long as a doctor’s request is made.

The question is: is there a risk for the elderly person who receives the vaccine? In an interview with Agência Brasil, geriatrician Paulo Villas Boas explained that the Qdenga leaflet does not include people over 60 years of age because no efficacy studies have been carried out in this age group. The member of the Immunization Committee of the Brazilian Society of Geriatrics and Gerontology highlighted, however, that the dose was released for the entire population over 4 years of age by the European Medicines Agency and the Argentine Medicines Agency.

“In the medium term, I believe there will be a discussion about releasing the dengue vaccine for the population over 60 years of age,” he said. “At this time, seniors are not eligible. If the dose is used in the population over 60 years of age, even if it is recommended by a doctor, it is considered what we call an off-label prescription, that is, one that is not included in the official release. Some medications are prescribed this way because there are studies that show benefit.”

“There is this possibility of off-label prescription. But what is happening in Brazil nowadays? There is a huge demand from the elderly population who want to be vaccinated against dengue. However, even in private clinics, the vaccine is no longer available. As it was released, the laboratory itself is unable to meet the demand for the SUS. We have a forecast, by the end of the year, of a supply of around 6 million doses. So the laboratory will probably not be able to meet the demand for private clinics.”

Villas Boas recalled that the elderly are considered a risk group for problems resulting from dengue infection. The highest number of deaths, according to the geriatrician, occurs precisely in this age group. Data from the Rio Grande do Sul Health Department, for example, show that, last year, of the 11 deaths recorded from the disease, eight were in people over 60 years of age. In 2022, 79% of deaths caused by dengue in the state were also among the elderly.

“We know that elderly people suffer from chronic diseases such as hypertension, diabetes and heart disease. Many have been on immunosuppression, that is, a breakdown in immunity. And these are risk factors for complications from dengue infection. Therefore, I believe that in the medium term, or even in the short term, we will have scientifically robust data that indicate vaccination against dengue fever for this population.”

The geriatrician reinforced that there is no imminent risk for elderly people who, with a medical prescription in hand, receive the dengue vaccine, but highlighted aspects considered important when it comes to immunizing people over 60 years of age, such as a state of loss of normal age-related immunity, called immunosenescence, and taking medications that can increase immunodeficiency, such as the chronic use of corticosteroids and other specific treatments.

“If this elderly individual eventually wishes to be vaccinated, it is important that they speak very well with the doctor who will prescribe the vaccine. A good health context for this elderly individual, so that they can receive the vaccine in complete safety. We have to remember that Qdenga is a vaccine with an attenuated virus and not a killed virus. If the individual has lower immunity, they may have a greater vaccine response or reaction, developing side effects inherent to vaccination, such as general malaise and fever. You will not develop a classic dengue condition. But it can have a series of side effects, described in the vaccine leaflet itself.”

In the absence of a dose against dengue formally indicated for the elderly, Villas Boas highlighted that preventing the disease in this age group must be carried out through measures already widely publicized to combat the Aedes aegypti mosquito: preventing the accumulation of stagnant water; use repellents especially in the morning and late afternoon, times of greatest circulation of Aedes aegypti; and wear long-sleeved clothes in lighter tones.

“Dengue prevention for the elderly population is identical to prevention for the general population. There is nothing specific. These are the guidelines that we get tired of hearing and tired of seeing that people don’t follow,” she said. “Anything that can prevent the individual from being bitten contributes,” she concluded.

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