During the introduction of the rotavirus vaccine in Latin America some countries did not allow sufficient time to train all health care workers in vaccine administration, leading to uncertainty regarding

possible contraindications and AEFI, reconstitution and administration, the interval between doses and minimum/maximum ages for administration [36]. For the successful introduction of a dengue vaccine, comprehensive education buy Ruxolitinib programmes will need to be in place and enough time must be taken to ensure that they are completed. Programmes for NIP managers, vaccine providers, paediatricians, other clinicians and nurses, and the general public will be required. In addition, it will be important to educate policymakers on the extent of the dengue burden, the increasing spread of dengue and the cost-effectiveness

of a dengue vaccine. It will also PI3K inhibitor help to train decision-makers, and those that advise them, in the understanding of computational models and demonstration projects so that they might fully understand the data generated. Given the potential controversies that surround every vaccine, together with those unique to a dengue vaccine, expert advisory bodies with the ability to offer second opinions and advice should be established. These advisory bodies will be able to support health care workers and programme managers at the time of vaccine introduction by providing informed responses to issues and concerns based on up-to-date information. Such a body would be able to coordinate responses to ensure that only the most accurate information is

shared. A proactive communication strategy targeting vaccine providers, authorities, clinicians and the public will also be essential to manage potential myths and controversies. These may only include concerns about a genetically modified vaccine, the risk of ADE, other potential severe AEFIs (both real and misattributed), media misinformation, public rumour and coincidental events during vaccine introduction (including dengue outbreaks). Adequate funding will be essential to support the effective introduction of a dengue vaccine. There are two key funding issues to be addressed: (i) obtaining initial funding for vaccine introduction, and (ii) establishing sustainable funding to support an ongoing vaccination programme. Initial funding will need to cover all associated costs of vaccine introduction outlined above, including logistics, vaccine supply, education, and surveillance costs. Funding for an ongoing vaccination programme will need to cover ongoing maintenance of these requirements and, potentially, the expansion of the programme, including catch-up vaccination. To secure funding it will be critical to demonstrate the cost-effectiveness of dengue vaccination. Convincing data showing that a hepatitis B vaccine was cost-effective were required before it was introduced into the NIPs of developing countries [46].