Dengue Incidence Following Mass Vaccination: An Interrupted Time Series Study in Paraná, Brazil

In southern Brazil, dengue transmission in the state of Paraná has shown a significant increase in the number of cases since the first recorded occurrence in 1995, with more frequent outbreaks in the west, northwest, and north of the state. We evaluated the impact of a campaign of dengue vaccination administered to a fraction of the population in 30 municipalities in the state by conducting a 15-year interrupted time-series ecological study using data obtained from an official Brazilian data register. We modeled dengue incidence using Poisson regression adjusted by covariates (demographic, climate, and epidemiological factors), allowing for specific temporal variation for each site. A reduction of 18.7% in dengue incidence rate was estimated for a vaccination coverage of 100%. Although there was an increase in the crude dengue incidence rate, considering the three-dose coverage achieved in the municipalities, we estimated an 8.2% relative reduction in the incidence rate. This reduction would increase to 17% with a hypothetical coverage of 90%. The campaign was more effective in small municipalities since they had higher vaccination coverage. These findings underscore the significant impact of the vaccination campaign on reducing dengue incidence trends across the targeted municipalities.