‘All stakeholders need to come together to tackle burden of dengue in India’

‘All stakeholders need to come together to tackle burden of dengue in India’

The threat of dengue, a viral infection, on humans, has increased drastically over the years. According to the World Health Organization (WHO), about half of the world’s population is now at risk of dengue with an estimated 100–400 million infections occurring each year.

Every year on May 16, National Dengue Day is observed in India to create awareness about dengue; and to intensify preventive measures and preparedness for the control of the disease in the country before transmission season starts.

Today, the Indian Council of Medical Research (ICMR) along with the Drugs for Neglected Diseases Initiative (DNDi) conducted an awareness session on “Together Against Dengue: Building a Stronger and Safer Community,” emphasizing the importance of collective action to combat dengue.

Key industry leaders like Dr Tanu Jain, Director, NCVBD, MoHFW, GoI, Dr Kalpana Barua, Former Additional Director, NCVBDC, Dr Nivedita Gupta, Head, Epidemiology and Communicable Diseases, ICMR, Dr Kavita Singh, Director, DNDi-South Asia, Dr Himmat Singh, Scientist E ICMR-NIMR, New Delhi and Dr Rajni Kant, Director, RMRC and Head, Policy and Communications, ICMR talked about the status of dengue, its control, measure, and management. ICMR Chief Dr. Rajiv Bahl gave a welcome address during the session.

Status of Dengue in India

A recent Lancet study published in March this year revealed that climate change is influencing the incidence of Aedes aegypti and Aedes albopictus mosquito-borne dengue illnesses.

110,473 dengue cases were documented in India between January and October, 2022, which is similar to the number of cases reported in 2018 (101 192), the study revealed. Notably, there was a substantially higher number of dengue cases recorded in previous years: 188 401 in 2017; 157 315 in 2019; and 193 245 in 2021, it added.

According to the data from the National Center for Vector Borne Disease Control (NCVBDC), India reported 233,251 dengue cases and 303 deaths in 2022. Meanwhile, states like West Bengal (67,271), Bihar (13,972), Punjab (11,030), Rajasthan (13,491), Uttar Pradesh (19,821), and Delhi (10,183) had a major contribution to the dengue incidence of the country.

Dengue Vaccines: What is the status?

ICMR Chief Dr. Rajiv Bahl informed today that trials for Dengue vaccines are underway.

“The trials are underway but they have not yet fully started because we are waiting for the company to make the GMP product which could not be made three months ago. The company should be ready in August. So, those phase III trials should be initiated in a few months…,” Dr. Bahl told reporters.

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According to the presentation by ICMR during the press briefing today, call for ‘Express of Interest’ for collaborative phase 3 clinical trials for indigenous manufacturers was made in February last year. Dr. Nivedita Gupta, Head, Epidemiology and Communicable Diseases, ICMR, informed that two companies: Panacea Biotec and Serum Institute of India had applied.

According to ICMR, Panacea has done I/II and the trials have been completed on 100 adults between the ages of 18 and 60 years. Meanwhile, SII has completed phase one trials on 60 adults with the aim of safety evaluation. SII has also initiated I/II studies pediatric trials in India. Dr. Gupta also shared that they are also planning to conduct a pediatric-adult bridging study with the outcomes.

‘Dengue alliance- Importance of endemic countries to take the lead in R&D’

Dr Kavita Singh, Director, DNDi-South Asia emphasised that there is always a persistent fear of large outbreaks and healthcare systems getting over-burdened with the number of cases.

“COVID-19 has given us a lot of learnings…we have a similar immuno-pathological disease here…It’s a disease we should not be ignoring. We should be monitoring it very closely,” Dr. Singh said.

In 2022, the Dengue Alliance was launched. It is a global partnership led by institutions from dengue-endemic countries that aim to develop affordable and accessible treatments for dengue.

The Dengue Alliance works on joint projects to progress pre-clinical investigations of potential dengue treatments, test the efficacy of repurposed drug candidates, and implement clinical trials of the most promising drug candidates.

The alliance include members like Drugs for Neglected Diseases Initiative (DNDi), Switzerland, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, Ministry of Health, Malaysia, Oswaldo Cruz Foundation (Fiocruz), Brazil, Translational Health Science and Technology Institute (THSTI), India and Universidade Federal de Minas Gerais (UFMG), Brazil.

Dr. Singh also maintained that there is a need to follow a ‘portfolio approach’ which involves neglected patients, public health priorities, and affordability.

Genetically-Modified Mosquitoes: Are they helpful?

Aedes aegypti mosquitoes spread viruses including dengue, Zika, and chikungunya. According to Center for Disease Control and Prevention (CDC), Ae. aegypti mosquitoes can be genetically modified and used to control other Ae. aegypti mosquitoes in a community.

“So the genetically modified mosquitoes, there is a company called Oxitec and they had come up with the technology for genetically modified mosquitoes when perhaps the primary focus is to create sterile insects. So wild-type males, like the males are released into the environment and when they mate the wild type females, then the product that is released or created, either they die at the larval stage, they can’t mature to an adult, and if they mature, then they are sterile. So basically there is an idea of population reduction of the mosquitoes subsequently. However, there are several techniques of genetically modified mosquitoes, but this is the primary focus,” Dr. Gupta told Financial Express.com.

She also highlighted that in ICMR they have largely debated this issue starting from 2017, but then the other hazards of genetically modified mosquitoes that are still not understood.

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“…they may harbor some other viruses or start transmitting some other diseases which we are not aware of….These are questions which are actually speculations, but there are no clear-cut answers or established safety parameters for these kind of questions. So we thought it was too big a risk to take as far as our country is concerned, because once they become rampant, we have no means and measures to control them. So that is why we did not venture into this particular technology, though we are very open scientifically to look at it, and then as and when more data keeps on evolving, and these concerns are settled. Maybe there will be a time when we as a country will be able to look at GM mosquitoes,” she said.

However, she also emphasised they are open to understanding modified vector for reduction in disease transmission.

“…And ICMR-VCRC took up Wolbachia-based vector control interventions. We are working on that technology which has been transferred from the Monash University in Australia. And this Wolbachia is a natural biocontrol agent that has been used for control of several pests in plants. So the use of Wolbachia was considered to be safe and it is understood that Wolbachia in 80s would not let the virus live. So any mosquito which harbors Wolbachia would not harbor the virus. So seeing the medium of genetically modified or modified mosquitoes, Wolbachia mosquito since it is already in nature and it is a natural biocontrol agent, it was considered to be a much safer technology than GM mosquitoes at the moment,” she added.

But I am again reiterating that with the evolution of more scientific data and knowledge, there can be a possibility that we also go ahead for GM mosquitoes in the future, but not now, she pointed out.

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Takeaways from COVID-19

Dr Rajni Kant, Director, RMRC and Head, Policy and Communications, ICMR told Financial Express.com that key takeaway from COVID-19 is the accuracy of the data number because during COVID-19 we were getting the correct information from all parts of the country.

“…Number of cases were happening. So number one is the wall footing research on the key priority areas. In today’s discussion, we were talking in the morning about diagnostics, if we can have a good, highly effective, sensitive rapid diagnosis for diabetes, that is again a very important area that we can take. Because during COVID-19, there was nothing when COVID struck. And within a short period of time, from one lab to 3,000 labs, from no testing to rapid antigen testing, then the COVID commercialization, everything that came up, and no vaccine, and the vaccine also came up. So many things we can learn from COVID-19. Definitely, the diagnosis is number one. Vaccine development is definitely number two. And community awareness is again very, very important while we are working for the dengue because it is the role of the community,” Dr. Kant told Financial Express.com.

According to Dr. Kant, they themselves can prevent the breeding, because it is a man-made mosquito breeding source, which is causing the problem of dengue because it is the aegypti as well as the albopictus.

“…aegypti is the major breeding in urban areas, in the domestic water container, inside house tanks, overhead tanks, systems, in the vessels and everywhere. So I think if the people are aware where the mosquito can breed if they can remove those small items, that will help in the reduction of the mosquito density and ultimately in the reduction in the number of cases. That’s it,” he added.

On Public-Private Partnerships, Dr. Gupta told that this partnership can help with scaling up diagnostics capacity.

“So first, as we have been talking about scaling up diagnostic capacity, so this is something which will definitely come through public-private partnership only. And for that what we are planning in a big way is that, and we have reached out to the Department of Biotechnology also,” she added.

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