Bhatt, S. et al. The global distribution and burden of dengue. Nature 496, 504–507 (2013).
Stanaway, J. D. et al. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect. Dis. 16, 712–723 (2016).
Yang, X., Quam, M. B. M., Zhang, T. & Sang, S. Global burden for dengue and the evolving pattern in the past 30 years. J. Travel Med. 28, taab146 (2021).
Halstead, S. B. Pathogenesis of dengue: challenges to molecular biology. Science 239, 476–481 (1988).
Katzelnick, L. C. et al. Antibody-dependent enhancement of severe dengue disease in humans. Science 358, 929–932 (2017).
Capeding, M. R. et al. Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial. Lancet 384, 1358–1365 (2014).
Villar, L. et al. Efficacy of a tetravalent dengue vaccine in children in Latin America. N. Engl. J. Med. 372, 113–123 (2015).
Sridhar, S. et al. Effect of dengue serostatus on dengue vaccine safety and efficacy. N. Engl. J. Med. 379, 327–340 (2018).
Hadinegoro, S. R. et al. Efficacy and long-term safety of a dengue vaccine in regions of endemic disease. N. Engl. J. Med. 373, 1195–1206 (2015).
World Health Organization Dengue vaccine: WHO position paper, September 2018—recommendations. Vaccine 37, 4848–4849 (2019).
Biswal, S. et al. Efficacy of a tetravalent dengue vaccine in healthy children and adolescents. N. Engl. J. Med. 381, 2009–2019 (2019).
Tricou, V. et al. Long-term efficacy and safety of a tetravalent dengue vaccine (TAK-003): 4.5-year results from a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Glob. Health 12, e257–e270 (2024).
World Health Organization Meeting of the Strategic Advisory Group of Experts on Immunization, September 2023: conclusions and recommendations. Wkly Epidemiol. Rec. 98, 599–620 (2023).
Blaney, J. E. Jr., Durbin, A. P., Murphy, B. R. & Whitehead, S. S. Development of a live attenuated dengue virus vaccine using reverse genetics. Viral Immunol. 19, 10–32 (2006).
Kallas, E. G. et al. Safety and immunogenicity of the tetravalent, live-attenuated dengue vaccine Butantan-DV in adults in Brazil: a two-step, double-blind, randomised placebo-controlled phase 2 trial. Lancet Infect. Dis. 20, 839–850 (2020).
Kallas, E. G. et al. Live, attenuated, tetravalent Butantan-dengue vaccine in children and adults. N. Engl. J. Med. 390, 397–408 (2024).
Nogueira, M. L. et al. 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. Lancet Infect. Dis. 24, 1234–1244 (2024).
Brasil. Ministério da Saúde, Secretaria de Vigilância em Saúde. Dengue: diagnóstico e manejo clínico: adulto e criança. Diretoria Técnica de Gestão 4th edn (in Portuguese) (2013).
Glasner, D. R., Puerta-Guardo, H., Beatty, P. R. & Harris, E. The good, the bad, and the shocking: the multiple roles of dengue virus nonstructural protein 1 in protection and pathogenesis. Annu. Rev. Virol. 5, 227–253 (2018).
Vannice, K. S. et al. Clinical development and regulatory points for consideration for second-generation live attenuated dengue vaccines. Vaccine 36, 3411–3417 (2018).
Brasil, Ministério da Saúde, Secretaria de Vigilância em Saúde. Monitoramento das arboviroses e balanço de encerramento do Comitê de Operações de Emergência (COE) Dengue e outras Arboviroses 2024. Boletim Epidemiológico 55, 11 (in Portugese) (2025).
Nivarthi, U. K. et al. A tetravalent live attenuated dengue virus vaccine stimulates balanced immunity to multiple serotypes in humans. Nat. Commun. 12, 1102 (2021).
Russell, K. L. et al. A phase I randomized, double-blind, placebo-controlled study to evaluate the safety, tolerability, and immunogenicity of a live-attenuated quadrivalent dengue vaccine in flavivirus-naive and flavivirus-experienced healthy adults. Hum. Vaccin. Immunother. 18, 2046960 (2022).
Whitehead, S. S. et al. In a randomized trial, the live attenuated tetravalent dengue vaccine TV003 is well-tolerated and highly immunogenic in subjects with flavivirus exposure prior to vaccination. PLoS Negl. Trop. Dis. 11, e0005584 (2017).
Durbin, A. P. et al. A 12-month-interval dosing study in adults indicates that a single dose of the National Institute of Allergy and Infectious Diseases tetravalent dengue vaccine induces a robust neutralizing antibody response. J. Infect. Dis. 214, 832–835 (2016).
Faria, N. R. et al. Zika virus in the Americas: early epidemiological and genetic findings. Science 352, 345–349 (2016).
Campos, G. S., Bandeira, A. C. & Sardi, S. I. Zika virus outbreak, Bahia, Brazil. Emerg. Infect. Dis. 21, 1885–1886 (2015).
Zambrana, J. V. et al. Primary exposure to Zika virus is linked with increased risk of symptomatic dengue virus infection with serotypes 2, 3, and 4, but not 1. Sci. Transl. Med. 16, eadn2199 (2024).
Estofolete, C. F. et al. Influence of previous Zika virus infection on acute dengue episode. PLoS Negl. Trop. Dis. 17, e0011710 (2023).
Nunes, K. et al. Admixture’s impact on Brazilian population evolution and health. Science 388, eadl3564 (2025).
Whiteman, M. C. et al. Virus reduction neutralization test: a single-cell imaging high-throughput virus neutralization assay for dengue. Am. J. Trop. Med. Hyg. 99, 1430–1439 (2018).
Johnson, B. W., Russell, B. J. & Lanciotti, R. S. Serotype-specific detection of dengue viruses in a fourplex real-time reverse transcriptase PCR assay. J. Clin. Microbiol. 43, 4977–4983 (2005).
World Health Organization. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control new edn. (World Health Organization, 2009).
Blackwelder, W. C. Sample size and power for prospective analysis of relative risk. Stat. Med. 12, 691–698 (1993).
Beran, J. et al. Challenge of conducting a placebo-controlled randomized efficacy study for influenza vaccine in a season with low attack rate and a mismatched vaccine B strain: a concrete example. BMC Infect. Dis. 9, 2 (2009).
Bhandari, N. et al. Efficacy of a monovalent human-bovine (116E) rotavirus vaccine in Indian infants: a randomised, double-blind, placebo-controlled trial. Lancet 383, 2136–2143 (2014).
Brown, L. D., Cai, T. T. & DasGupta, A. Interval estimation for a binomial proportion. Stat. Sci. 16, 101–117 (2001).
Chan, I. S. F. & Bohidar, N. R. Exact power and sample size for vaccine efficacy studies. Commun Stat.-Theor M. 27, 1305–1322 (1998).
Blaker, H. Confidence curves and improved exact confidence intervals for discrete distributions. Can. J. Stat. 28, 783–798 (2000).