Dengue viruses are endemic in most tropical and subtropical countries where they produce disease ranging from a mild
fever to a severe, potentially fatal vascular permeability syndrome. We reviewed the status of development and testing in children of three
vaccines designed to protect against the four dengue viruses. The first dengue virus
vaccine, Dengvaxia, now licensed in 20 endemic countries, the EU and the USA, provides protection against
severe dengue in seropositive individuals but increases the risk for naive recipients to develop
severe dengue and to be hospitalised. We discuss mechanisms and implications of shortcomings of the licensed
vaccine and describe the structure and attributes of two other dengue virus
vaccines. Based upon human
dengue challenge studies, one of these
vaccines promises to deliver solid, long-lasting immunity after a single dose. Because dengue virus
infections are ubiquitous in residents and visitors to tropical countries, in the absence of a protective
vaccine paediatricians should recognise the early signs and clinical presentation of
severe dengue, understand its pathophysiology and appropriate management.