{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:31:33Z","timestamp":1790620293693,"version":"4.1.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014062","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000}}],"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001349","name":"National Medical Research Council, Singapore","doi-asserted-by":"crossref","award":["MOH-001118-00"],"award-info":[{"award-number":["MOH-001118-00"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>Dengue virus, with all four serotypes in cocirculation, has created significant epidemiological and economic burdens in Singapore. Despite integrated vector control programs, the magnitude and frequency of dengue outbreaks has increased over the last few decades, which highlights the limits of existing strategies. In this context, vaccination has emerged as a promising approach to enhance population immunity and complement ongoing efforts. Qdenga (TAK-003), a commercially available dengue vaccine, has been recommended by the World Health Organization Strategic Advisory Group of Experts (WHO-SAGE) for use in high-transmission settings. Although classified as a low transmission setting, Singapore faces a recurring public health burden from dengue, with high costs associated with both healthcare and sustained vector control. The age distribution of dengue in Singapore differs from high transmission settings, with more cases in young adults and hospitalizations concentrated among older individuals. These factors, combined with the complex efficacy profile of Qdenga, varying by baseline serostatus, infecting serotype, make it challenging to directly apply global vaccination recommendations to Singapore. Therefore, the population-level impact of introducing dengue vaccination remains uncertain, underscoring the need for context-specific evaluation. To estimate the potential public health impact of introducing routine dengue vaccination in Singapore, we develop an age-stratified, multi-serotype, compartmental transmission model informed by age-specific dengue seroprevalence and routine surveillance data. Our model predicts that vaccination can avert up to on average 9%, 12%, 7%, and 5% cases in DENV-1\u20134 dominant serotype scenarios respectively, over a 10-year routine vaccination program with 80% vaccine coverage. Moreover, dengue hospitalizations can be reduced up to 15% across all dominant serotype scenarios. Our results suggest that, in Singapore, targeting older age groups will be more beneficial than the 6\u201316-year window recommended by the WHO-SAGE for high-transmission settings. Vaccinating individuals aged 17\u201330 years achieves the greatest reduction in cases, whereas targeting those aged 51\u201370 years leads to the highest reduction in hospitalizations. Our model-based analysis provides useful insights to support policymakers and public health authorities in designing evidence-based, dengue vaccination strategies in Singapore. The findings also underscore the importance of tailoring dengue vaccination programs to local epidemiological conditions for effective disease control.<\/jats:p>","DOI":"10.1371\/journal.pntd.0014062","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T18:32:01Z","timestamp":1772476321000},"page":"e0014062","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Adult dengue vaccination in a low transmission setting: A modelling study in Singapore"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1572-2658","authenticated-orcid":true,"given":"Abhishek","family":"Senapati","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tun-Linn","family":"Thein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yee-Sin","family":"Leo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah Eleanor","family":"Clapham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"issue":"7446","key":"pntd.0014062.ref001","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/nature12060","article-title":"The global distribution and burden of dengue","volume":"496","author":"S Bhatt","year":"2013","journal-title":"Nature"},{"issue":"6","key":"pntd.0014062.ref002","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/S1473-3099(16)00026-8","article-title":"The global burden of dengue: an analysis from the Global Burden of Disease Study 2013","volume":"16","author":"JD Stanaway","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"pntd.0014062.ref003","doi-asserted-by":"crossref","first-page":"16055","DOI":"10.1038\/nrdp.2016.55","article-title":"Dengue infection","volume":"2","author":"MG Guzman","year":"2016","journal-title":"Nat Rev Dis Primers"},{"issue":"6365","key":"pntd.0014062.ref004","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1126\/science.aan6836","article-title":"Antibody-dependent enhancement of severe dengue disease in humans","volume":"358","author":"LC Katzelnick","year":"2017","journal-title":"Science"},{"issue":"5","key":"pntd.0014062.ref005","doi-asserted-by":"crossref","first-page":"910","DOI":"10.4269\/ajtmh.2007.77.910","article-title":"Analysis of Repeat Hospital Admissions for Dengue to Estimate the Frequency of Third or Fourth Dengue Infections Resulting in Admissions and Dengue Hemorrhagic Fever, and Serotype Sequences","volume":"77","author":"RV Gibbons","year":"2007","journal-title":"Am J Trop Med Hyg"},{"issue":"6","key":"pntd.0014062.ref006","article-title":"Singapore\u2019s 5 decades of dengue prevention and control-Implications for global dengue control","volume":"17","author":"SH Ho","year":"2023","journal-title":"PLoS Negl Trop Dis"},{"issue":"8","key":"pntd.0014062.ref007","article-title":"A greener vision for vector control: The example of the Singapore dengue control programme","volume":"14","author":"S Sim","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"10","key":"pntd.0014062.ref008","article-title":"Economic impact of dengue in Singapore from 2010 to 2020 and the cost-effectiveness of Wolbachia interventions","volume":"1","author":"S Soh","year":"2021","journal-title":"PLOS Glob Public Health"},{"issue":"6","key":"pntd.0014062.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012240","article-title":"The epidemiologic and economic burden of dengue in Singapore: A systematic review","volume":"18","author":"R Ting","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"issue":"12","key":"pntd.0014062.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0001426","article-title":"Economic impact of dengue illness and the cost-effectiveness of future vaccination programs in Singapore","volume":"5","author":"LR Carrasco","year":"2011","journal-title":"PLoS Negl Trop Dis"},{"issue":"11","key":"pntd.0014062.ref011","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1016\/S1473-3099(24)00376-1","article-title":"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","volume":"24","author":"ML Nogueira","year":"2024","journal-title":"Lancet Infect Dis"},{"key":"pntd.0014062.ref012","unstructured":"WHO. 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