The Australian Technical Advisory Group on Immunisation has just released (24 September 2026) its long-awaited recommendations on the use of the new tetravalent dengue fever vaccine, Qdenga.

Read the ATAGI statement on the clinical use of the dengue vaccine Qdenga for Australians.

What the ATAGI advice means for travel health practitioners

The advice is good news for travel health practitioners as it gives agency to those who prescribe vaccines using a risk-based approach. The advice takes into account the excellent safety record of the vaccine since the start of vaccine trials in 2016 and the current levels of surveillance provided by the manufacturer.

Travel health practitioners can now focus on the risk of exposure based on the actual destination of travel, the activities of the individual and any comorbidities which might increase their risk of serious disease. This is good travel medicine where the focus is more about educating the traveller rather than prescribing from a cookbook.

The risk of exposure for someone staying for a few days in a 5-star resort in an area of risk is very different to someone relocating to Indonesia on a long-term basis. The latter has cumulative risk which can be greater than 10% per annum. The advice also allows for consideration of the vaccine in older travellers (those over 60 years) who may have comorbidities which put them at a higher risk of severe disease. Technical bodies in several countries have limited its use in those over 60 years and this has created issues for expatriate residents overseas.

It also considers the long-term backpacker and cumulative exposure for frequent travellers to high-risk destinations.

The global burden of dengue fever

Dengue fever is a huge global health issue. Over 40% of the global population live in areas where dengue fever is found. According to WHO an estimated 100 to 400 million cases occur annually with 100 million hospitalisations and 20,000 deaths. The cost to the global health system is estimated in billions of dollars.

More than 5000 cases of imported dengue fever have been reported in Australia since January 2024.

High levels of current activity are being noted (September 2026) in Sri Lanka, Bangladesh, Cuba and parts of Southeast Asia.

The United States CDC provides area specific information.

Healthy Travel often provides commentary on these outbreaks, including the high number of dengue fever cases in Bangladesh and the dengue fever outbreak in Samoa.

About the Qdenga vaccine: schedule, efficacy and safety

Qdenga is a live attenuated tetravalent vaccine. It is based on a "backbone" of the dengue serotype 2 virus and includes genetic material from all four dengue virus serotypes. More than 60,000 individuals have participated in trials in Latin America and Asia since 2016.

It is recommended from 4 years of age and given in a 2-dose schedule with a 3-month interval between doses. Protection is present from 14 days. The length of protection is yet to be defined but likely more than 4 years. Booster doses have not yet been defined.

A protective efficacy of between 60% and 95% (average 80%) for virologically identified dengue fever at 12 months post second dose and lasting for more than 4.5 years. The protective efficacy is greater for those who have had a previous dengue fever infection. It also varies according to the serotype of the dengue virus.

The vaccine has a good safety profile with injection site discomfort (50%), headache (35%), muscle aches and pains (31%), tiredness (24%) and fever (11%) mentioned. These reactions are common to many other vaccinations. Side effects are more likely after the first dose than the second.

The vaccine cannot be given to women who are pregnant or breastfeeding. It should also be avoided in those with congenital or acquired immune deficiency. People living with HIV who are not immunocompromised can be given the vaccine (CD4 count assessment).

The product information can be sourced through the TGA website.

The World Health Organization has placed Qdenga on a list of "Prequalified vaccines" where it might be used in public health programs to reduce the risk of serious disease.

Dengue fever risk for travellers

The European Centre for Disease Prevention and Control (ECDC) recently published (April 2026) a dengue fever disease notification rate per country (per 100,000 travellers) for 2023. Of interest in our region were the number of cases for Thailand (577), and Indonesia (166). The report also noted cases from 78 countries in the 3 months, December 2025 to February 2026.

Dengue fever is a vector-borne disease. The virus is transmitted to humans by a mosquito bite. Humans are the only known reservoir of infection.

Outbreaks of dengue are not uncommon in the months following peak wet season.

Residual water in an urban environment provides good breeding sites (empty rubbish cans, pot plant saucers and ponds) for the mainly urban mosquito, Aedes aegypti.

Public health interventions are mostly aimed at communicating mosquito avoidance health messages to individuals at risk (including travellers) and reducing breeding sites at a local level.

Travellers should be reminded of the risk of dengue fever and other mosquito-borne diseases when travelling to areas of risk. This may even include northern Australia.

For more information, see mosquito avoidance measures.

Who should consider dengue fever vaccination?

Vaccination for dengue fever is now a possibility for some travellers. It should certainly be considered in those who have had a previous documented bout of dengue fever. It might also be a consideration for expatriate workers and for those who have lived for long periods of time in an endemic area.

A recommendation should be made on a case-by-case basis once a supply has been established in Australia.