OBJECTIVES: The objective of this study was to estimate the public health impact of potential dengue vaccination programs targeting children one year and older in Indonesia.

METHODS: We developed a comprehensive deterministic, age-stratified, four-serotype dynamic transmission model for dengue to evaluate the population-level effectiveness of potential dengue vaccine candidates. Using the model, which was parameterized and calibrated with country-specific demographic and epidemiological data, we assessed the number of symptomatic cases, asymptomatic cases and hospitalizations averted through routine single-dose vaccination of the population over a 10-year time-horizon. To address vaccine and programmatic uncertainties, a total of 22,680 scenarios were conducted: vaccine efficacy against symptomatic infection (VE) for each serotypes varied between 50–90%, vaccine coverage rate (VCR) varied between 30–90%, vaccine protection duration (VD) varied between 5–10 years, and age at vaccination varied from 1-20 years.

RESULTS: In the absence of a universal dengue vaccination program, we estimated an annual incidence of 3.5 million symptomatic cases (35 million cumulative cases over 10 years) in Indonesia. Out of all the scenarios considered, the optimal age for vaccination was consistently one year old. In the most effective vaccination program scenario (i.e., VE: 90%; VCR: 90%; VD: 10 years; vaccination age: 1 year), we estimated 17 million symptomatic cumulative cases (47%) would be averted over the 10-year time-horizon. Holding all other variables constant, the effectiveness of the vaccination program decreased with increasing vaccination age. For example, vaccination programs targeting 6- and 18-year-olds averted 5-11% and 21-47% fewer symptomatic cases than vaccination programs targeting one-year-olds, respectively. Results were similar for other outcomes.

CONCLUSIONS: For a hypothetical dengue vaccine, the optimal dengue vaccination strategy in Indonesia is to vaccinate children as soon as indicated.