Dengue Vaccination in Brazil: Vaccination coverage and impact on the incidence of severe cases

Brazil introduced dengue vaccination into its public health system during an exceptionally large epidemic, making both vaccine uptake and prevention of severe outcomes central policy questions. This narrative and critical review examines the implementation of dengue vaccination in Brazil, available coverage indicators, and evidence linking vaccination to severe disease, especially hospitalisation. PubMed-indexed clinical and observational studies, World Health Organization recommendations, Brazilian surveillance documents, and regulatory communications available through 2026 were examined. National administrative reports documented 7.6 million first doses and 4.2 million second doses by October 2026, but these counts are not population-based coverage estimates. A study of priority municipalities found marked geographic heterogeneity. In São Paulo, one-year observational effectiveness against dengue hospitalisation was 74.6% after one TAK-003 dose and 87.9% after two doses, consistent with trial evidence of substantial protection against hospitalised disease. The distinct Butantan-DV programme was temporarily interrupted in June 2026 for investigation of a post-introduction safety signal. Although individual-level protection against hospitalisation is supported, the vaccine-attributable change in Brazil's national incidence of strictly defined severe dengue has not been established. Coverage completion, harmonised outcome definitions, and linked surveillance are essential to evaluate population impact.