Volume 13, Number 16 August 19 – September 8, 2007
business & economy
Months ago, they said that full financing was lined up and almost all of the units were pre-sold…
Trump Tower project tries to sell bonds
by Eric Jackson
The most heralded symbol of Panama City’s upscale construction boom, the Trump Ocean Club, International Hotel & Tower Panama, appears to be in serious trouble. The $404 million project, which bears Trump’s name but whose main promoter is Colombian developer Roger Khafif, was according to rosy press releases issued last year fully financed and almost entirely pre-sold. Now the Newland International Properties Corporation, the consortium created for the project, has applied to Panama’s Comision Nacional de Valores (National Securities Commission) for permission to sell $220 million in private bonds to complete the sail-shaped luxury condo and hotel tower.
When the project was first announced, $220 million was the cost figure that Khafif and Trump first cited. That figure has in less than two years risen to $404, which can’t be entirely explained by rising materials and labor costs. Pre-construction buyers of units in the project had to put 20 percent of the price down, with further payments coming due well before the properties they bought are ever ready for occupancy. Notwithstanding that, a lot of the units have been “flipped” by speculators for even higher prices than would be owed to the developers. Work began on the project in May but is not at a very advanced stage.
That Khafif and Trump have had to go the private bond issue route is an indication that the promoters can’t get ordinary bank financing. Speculation among people in the real estate and construction industries is that with the US housing market in trouble and thus the anticipated trend of baby boomers exchanging their homes in the states for new places in Panama likely to slow as a result, and with the collapse of several other high-profile construction projects, it’s going to be hard to sell those bonds to private investors as well.
However, another current of murmurs from among a section of the real estate industry and its acolytes has it that if the Trump project collapses it will take the rest of Panama City’s upscale housing construction boom with it, and thus everyone who has Panama’s best interests in mind will support whatever it takes to rescue the development. It can be reasonably anticipated that, with the privatizations of several public pension funds, these murmurs may mutate into an insistence that public employees’ retirement funds or the Social Security Fund buy these bonds. In the latter case the 2005 privatization law requires that bonds be rated at least AA for Seguro Social to buy them and in any case that would put Colombian and American interests in competition with Panama’s oligarchy for control of a major portion of the country’s retirement savings. There will be no public bailout of the Khafif/Trump project without a huge controversy that will not only reignite the 2005 brawl over pension fund privatizations but most likely also divide the nation’s business sectors.
A real estate analyst for the Dallas Morning News concluded that “It’s hard to find evidence that white-haired North Americans from Florida, California, New York, Texas and Canada are mounting an invasion of retirees, and you can almost hear the air escaping from this bubble.” One of the local developers who has long been skeptical of the speculation in high-end real estate in Panama City added that “They certainly will have difficulties selling the bonds and yes it shows that Khafif was full of BS when he said all financing was lined up.”
Tiburón ballena registra la migración
trans-pacífica más larga de la historia
Poco se sabe sobre los peces más grandes del mundo, apacibles gigantes que alcanzan los 12 metros (40 pies) de longitud. Investigadores del Instituto Smithsonian de Investigaciones Tropicales (STRI) y colegas rastrearon a una hembra de tiburón ballena desde el Pacífico Oriental hasta el oeste del Indo-Pacífico: 20,142 km (más de 12,000 millas) la ruta más larga de migración de un tiburón ballena jamás registrada.
El científico de STRI, Héctor M. Guzmán, etiquetó a una hembra de tiburón ballena (Rhincodon typus) cerca de la Isla Coiba en Panamá, la isla más grande frente a las costas de América Central, Parque Nacional, Patrimonio de la Humanidad y área marina protegida. Su equipo nombró al tiburón Anne en honor a la conservacionista Anne McEnany, presidenta y directora general del International Community Foundation (ICF). El proyecto de varios años también etiquetó a 45 tiburones adicionales en Panamá con el patrocinio del Fondo Candeo de Christy Walton en el International Community Foundation, junto con STRI y la Secretaría Nacional de Ciencia, Tecnología e Innovación de Panamá (SENACYT).
Guzmán estimó la posición de Anne basándose en las señales de una etiqueta de Posición y Temperatura Inteligente (SPOT) atada al tiburón, recibida por el Satélite de Investigación Avanzada y Observación Global (ARGOS). La etiqueta sólo se comunica con el satélite cuando el tiburón nada cerca de la superficie. Anne permaneció en aguas panameñas durante 116 días, luego nadó hacia la Isla Clipperton (Francia), cerca de la Isla del Coco (Costa Rica) en su ruta hacia la Isla Darwin en Galápagos (Ecuador), un sitio conocido por atraer grupos de tiburones. 266 días después de que la etiquetaron, la señal desapareció, lo que indica que Anne estaba a gran profundidad para ser rastreada. Después de 235 días de silencio, las transmisiones iniciaron nuevamente, al sur de Hawái. Después de una estadía de 9 días, continuó por las Islas Marshall hasta que llegó a la Fosa de las Marianas, un cañón en el fondo del océano cerca de Guam en el Pacífico Occidental donde el director James Cameron localizó el punto más profundo de la superficie de la Tierra a casi 11,000 metros (36,000 pies) debajo del nivel del mar.
Los tiburones ballena se sumergen a más de 1900 metros (6000 pies). Pero no se sabe qué estaba haciendo el animal en esta área. “Tenemos muy poca información sobre por qué migran”, comentó Guzmán, “¿Están buscando comida, buscando oportunidades de reproducción o impulsados por algo más?”
“A pesar de ser el pez más grande del mundo, me sorprende lo poco que sabemos sobre esta especie”, comentó Scott Eckert, coautor y profesor de biología en Principia College. “Cuando empecé a trabajar en ellos, se debatió su taxonomía, y aún no estaba claro cómo se reproducían”.
Se encuentran en aguas cálidas, tropicales y subtropicales, se cree que alrededor de una cuarta parte de los tiburones ballena viven principalmente en el Atlántico, mientras que aproximadamente tres cuartas partes viven en el Indo-Pacífico. Los turistas se sienten atraídos a los sitios donde se reúnen 500 o más tiburones ballena: en Omán, Australia, Galápagos, México, Mozambique, Seychelles. También se han reportado grandes grupos desde Taiwán, el sur de China y la costa de Gujarat en India.
Los estudios genéticos muestran que los tiburones ballena en todo el mundo están estrechamente relacionados, lo que indica que deben viajar largas distancias para aparearse. Se han rastreado tiburones ballena en distancias más cortas a lo largo de rutas similares, pero este informe es la migración más larga registrada hasta la fecha y la primera evidencia de una posible ruta transpacífica. Como Anne, otros tiburones ballena parecen seguir la Corriente Ecuatorial del Norte durante la mayor parte de la distancia. Las hembras grandes pueden nadar un promedio de 67 kilómetros (aproximadamente 40 millas) por día.
El tiburón ballena es uno de los tres tiburones que se alimentan por filtración y se alimenta de plancton, huevos de peces, krill, larvas de cangrejo, pequeños peces y calamar (además de plástico, que no pueden digerir). Como tales, no se consideran particularmente peligrosos y las compañías de turismo que ofrecen la oportunidad de nadar muy cerca de estos tiburones son comunes cerca de las áreas donde se reúnen en grandes cantidades. Pero su tamaño también atrae a los barcos pesqueros. Son buscados por sus aletas y carne, por sus dientes (utilizados en artesanías y vendidos a los turistas) y por el cartílago y el aceite con supuestos valores medicinales. Los tiburones ballena juveniles a menudo terminan como captura incidental junto con el atún y otras pesquerías.
Los tiburones ballena fueron clasificados como especies en peligro de extinción en el 2016. Durante los últimos 75 años, se estima que casi la mitad de los tiburones ballena del mundo han desaparecido. En muchas partes del mundo, los tiburones ballena tienen protección legal, pero las regulaciones a menudo no se imponen. Los datos de Guzmán se usaron para diseñar y redactar políticas locales y regionales para la protección de la especie. La pesca, captura y venta de tiburones ballena está prohibida en Panamá mediante el Decreto Ejecutivo No. 9, firmado en el 2009 y en el 2014, la Autoridad de Ambiente de Panamá aprobó una resolución adicional que regula el avistamiento de tiburón ballena en el Parque Nacional Coiba y la reserva marina Isla Canales de Afuera. La resolución incluye un Manual de observación de tiburones ballena, pero desafortunadamente las actividades turísticas no están bien organizadas y las autoridades no están presentes para hacer cumplir las regulaciones.
“Los tiburones ballena en Coiba ya han cambiado su comportamiento para evitar la superficie y a los turistas”, comentó Guzmán. “Estos estudios son fundamentales a medida que diseñamos las políticas internacionales para proteger especies transfronterizas como los tiburones ballena y otras especies marinas altamente migratorias”.
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Navarro’s alleged crime isn’t taking millions from
Odebrecht, but talking about how Varela did that
by Eric Jackson
At first there was flat-out denial. A Spanish-Brazilian witness who had played a key role in laundering the funds for Odebrecht’s international bribery and kickback operation, Rodrigo Tacla Durán, said that millions had been funneled from that notorious company to Juan Carlos Varela’s political apparatus. The president first denied it, but more witnesses and paper trails were uncovered to corroborate the story, so late last year the president changed his story. The money from Odebrecht was not a bribe, he said, but a campaign contribution.
Was that so? Foreign contributions in Panamanian election campaigns are still illegal. But if a Panamanian subsidiary of a foreign corporation and duly reported?
What actually happened was that the Brazilian construction-based conglomerate, through a bank that it controlled, Meinl Bank, sent millions to an Uruguayn company with a similar name to a North Carolina seafood company, Poseidon Enterprises. Odebrecht set up the Uruguayn Poseidon in the name of Varela’s cousin, sometimes diplomat and businessman Jaime Lasso. The money then made its way into a foundation that Lasso controls, the Fundacion Don James. From the foundation it went in to Varela’s Panameñista Party.
On January 30 of this year in a TVN interview, former Panama City mayor and two-time presidential hopeful Juan Carlos Navarro said that the Fundacion Don James “laundered money.” By all appearances that is what was done, but the Public Ministry takes the position that Ricardo Martinelli’s last attorney general, Ana Belfon, “investigated” the foundation for that and did not bring charges so any further proceedings are barred. And Lasso is taking the position that since he can’t be charged it never happened.
To falsely accuse somebody of a crime is half of the double offense of “calumnia e injuria.” It’s the calumnia part, to which the truth is a defense. But the gist of injuria is that, regardless of the truth, somebody’s reputation has been damaged. Lasso charged Navarro with calumnia e injuria and Navarro is blaming Lasso’s cousin, the president. It’s one of a series of charges being brought against Navarro, mostly under the election laws for things non-financial. It’s about Navarro attacking Varela, who beat him in 2014.
Navarro’s position in his party and public life was in shards after his 2014 defeat, but in the twists and turns of political fortune he may be moving toward the front of the pack running for the 2019 PRD presidential nomination. Most probably he trails legislator Zulay Rodríguez, who would turn the party into an anti-foreigner organization much like Donald Trump has changed the Republican Party in the United States, and former agriculture minister Laurentino Cortizo, who resigned from the Martín Torrijos administration over the damage he foresaw that “free trade” with the United States would do to Panama’s farmers. We don’t really know how things stand in the race because the Electoral Tribunal has forbidden the publication of public opinion polls. By most appearances, the charges have sparked new vigor into Navarro’s fortunes. Trying 12-year-old offenders as adults and taking a strong stand against same-sex marriages or any other rights for gays, lesbians, bisexuals or transgendered people did not seem to be generating much enthusiasm for Navarro on the campaign trail. The possibility of being the only person convicted in the Odebrecht affair — for denouncing what was done — is a much safer political position to occupy, so it would appear.
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These songbirds are found in highland pockets from southern Mexico to Tierra del Fuego. In Panama there are mostly a western highlands bird, but you find some in Veraguas and on Cerro Campana and Cerro Chame in Panama Oeste.
Estos pájaros cantores se encuentran en nichos de las tierras altas desde el sur de México hasta Tierra del Fuego. En Panamá hay principalmente en las tierras altas del oeste, pero se encuentran algunas en Veraguas y en Cerro Campana y Cerro Chame en Panamá Oeste.
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Hay que condenar la represión y las
medidas neoliberales de Daniel Ortega
por Olmedo Beluche
El gobierno de Daniel Ortega, del partido FSLN, ha procedido a realizar una drástica reforma de las pensiones, aumentando la cuota obrero patronal y descontando 5% de las jubilaciones de los actuales jubilados. Todo esto sugerido por el Fondo Monetario Internacional en una típica medida de corte neoliberal.
Por menos que esto, en Panamá, el movimiento popular organizó el Franadesso original, en 2005, se realizaron masivas movilizaciones y una huelga general. Así que es plenamente legítima, como lo fue la nuestra, la movilización de los estudiantes y trabajadores nicaragüenses contra la reforma que ahora impone el gobierno de Ortega. Movilizaciones masivas que han sido duramente reprimidas con su secuela de muertos.
Aquí es donde se evidencia la verdadera cara del llamado “progresismo” latinoamericano. Gobiernos que alardean de revolucionarios y chacharean de “socialismo”, pero que en la práctica no pasan los límites del sistema capitalista. La crisis del progresismo en todo el continente es la crisis del reformismo burgués, incapaz de verdaderas medidas socialistas en un momento de crisis sistémica y caída de precios de las materias primas.
Aquí no vale que el sandinismo aduzca la existencia de “conspiraciones” de la derecha y el imperialismo, si ellos mismos metieron la cabeza en la guillotina para aplicar una medida económica de derecha ordenada por el imperialismo (FMI).
Frente al reformismo burgués inconsecuente y frente a los proyectos de la extrema derecha proimperialista, es la hora de construir verdaderas alternativas políticas revolucionarias y socialistas.
Socialismo no son unas cuantas políticas públicas (“transferencias”, como las llama el Banco Mundial) financiadas por las exportaciones de materias primas, sin tocar el corazón de la propiedad capitalista. Socialismo es verdadera participación popular, con sus organismos de poder, con su democracia, con la nacionalización de la banca y el comercio exterior.
Podemos defender a Nicolás Maduro de la política golpista de Estados Unidos y la derecha venezolana, pero hay que decir que, igual que Ortega en Nicaragua, tiene responsabilidad en la crisis actual, por lo que ha hecho y dejado de hacer.
Otro tanto de Lula, a quien defendemos de la conspiración derechista para sacarlo de la contienda electoral, pero cuyas políticas reformistas dieron alas a la derecha, incluso su partido, el PT, le regaló al golpista M. Temer, la vicepresidencia al lado de Dilma Rousseff.
Lo que pasa hoy en Nicaragua debe ser un llamado de atención a los verdaderos revolucionarios y socialistas del continente del deber de construir una verdadera alternativa de la clase trabajadora, por fuera de la sombra de “progresistas” y reformistas inconsecuentes, que llevan a la derrota de los movimientos antineoliberales que iniciamos hace 20 años.
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Say WHAT? It’s the end of legislative
year scramble — that much we know
by Eric Jackson
On April 30 a legislative year ends. As that date approaches, legislatures usually play games. There are names for some of the more popular ones. The camaron — literally, shrimp — is a usually tasty little morsel, for someone, snuck into a bit of legislation about some other subject. A madrugonazo is legislation, generally by way of an amendment to soemthing else, brought up and jammed through in the wee hours the morning. The whole point of either is a sneak attack, of public business done without public notice or explanation, usually because if a close examination is allowed it would not pass the smell test.
On Saturday, the 21st of April, Panamanians woke up to see their screens or in print news of a camaron, an amendment to a proposed zoning law brought up by PRD deputy Roberto Ayala. It was added without much debate or examination. The amendment repeals another camaron that was jammed through the legislature in 2014 at the end of Ricardo Martinelli’s administration and that legislature’s session, and signed into law nearly a year later by Juan Carlos Varela.
The 2014-2015 sleight of hand awarded a port concession to PSA, whch used to stand for Port of Singapore Authority before a 1997 Singaporean government reorganization, on a parcel just north of the old Rodman Naval Station piers. At the time what did get some notice and prompt some objections was that the real estate in question had already been conceded to somebody else, a company called PIMPSA, which over the years had various environmentally obnoxious land useideas. PIMPSA’s 1997 concession forbade its transfer.
So, at the end of the Martinelli administration, goodbye to a company that wanted to put in a cement factory to send out clouds of grit to mess with the instruments and crews of passing ships? Maybe there was merit to that, but that particular question had already been decided against the company, which surely wanted to unload a concession that proved not so profitable to itself. PSA, which had already bought some rights to the old Rodman piers back in 2008, got the property.
There was that ban on transfers, but senior in authority to the provisions of a concession contract in Panamanian law is the constitution.
Article 3 of the Political Constitution of the Republic of Panama is the fruit of a generations-long anti-colonial struggle, a controversy over which Panamanians died:
…The national territory may never be ceded, transferred or encumbered, not even temporarily, not even partially, to other states.
The Republic of Singapore is a sovereign city-state. Starting in the late 1990s as privatization was all the neoliberal rage, it began to devolve its port authority. But actually, it just put two layers of government between itself and the company created out of the authority. PSA International Pte Ltd, which wholly own the PSA Panama International Terminal concession, is one of the world’s major seaports companies. It is a subsidiary of Temasek Holdings Private Limited (Temasek), which despite the name is a wholly state-owned Singaporean sovereign wealth fund. PSA is the Singaporean government, analogous to how the old Panama Canal Company was the US government. Yes, they can play organizational chart and semantic games, but PSA’s concession at Rodman is a cession of Panamanian territory to another state.
The picture back in 2015 was made just a bit stranger by the presence of one individual, Guillermo Liberman, as a director of both PIMPSA and PSA’s Panama subsidiary.
To several lawyers the whole thing looked just wrong, although stated suspicions of some sort of corruption in the deal have never been specified. In any case, there were lawsuits filed which cited the non-transferability of the PIMPSA concession and another section of the constitution, Article 290, which generally forbids the acquisition of “domain” over national territory by foreign governments and their official or semi-official entities. Those lawsuits have languished undecided for three years now.
In the intervening time, PSA has made a substantial investment in the port. Legal concession or not, the company has changed its position in reliance upon the contract and there are international agreements which say that such things matter.
The morning was not over before President Varela promised a veto, business groups complained that things like this tell foreign investors that there is no rule of law here and the PRD legislative caucus backtracked on what it had done a few hours earlier. PSA is unlikely to lose its concession by a political process anytime soon. They may yet lose it in the courts, but that would be a very outside chance.
Rule of law upheld? Not especially.
Would the expulsion of PSA cripple the nation’s maritime industry? Not especially. That port is not particularly busy. On the west bank of the canal it’s not served by the multimodal rail link among most of the seaports in Panama City and Colon. A new bridge, more or a road infrastructure and new train lines might alter the equation in the not so distant future.
So who wanted to take the concession away? Why? We really haven’t heard an explanation from Mr. Ayala. The general public mood is to suspect crude theft by dark forces. But we really don’t know.
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Revised SAGE recommendation on use of dengue vaccine
by the World Health Organization (WHO)
WHO published the recommendations of the Strategic Advisory Group of Experts on Immunization (SAGE) on the use of Dengvaxia® on 27 May 2016, and subsequently a WHO position paper on dengue vaccine on 29 July 2016.
Following the disclosure of new data on Dengvaxia® by its manufacturer, Sanofi Pasteur, on 29 November 2017 (as described in more detail below), WHO`s Global Advisory Committee on Vaccine Safety (GACVS) and the WHO Secretariat published interim statements on December 7, 20171, and December 22, 20172, respectively. WHO initiated a process engaging independent external experts to review the data in detail, and reconvened the SAGE working group on dengue vaccines. This process has led to revised recommendations from SAGE on 18 April 2018. An updated WHO position paper on dengue vaccine will be published in September 2018.
The purpose of this document is to supplement the WHO ”Question and Answer” document from December December 22, 20172.
Dengue is the most frequent and rapidly spreading mosquito-borne virus. The first dengue vaccine, CYD-TDV (Dengvaxia®) is currently licensed in twenty countries. The key findings from two large Phase 3 trials involving over 30,000 participants aged 2 to 16 years included:
Vaccine efficacy against virologically confirmed dengue, over a 25-month period from the first dose of a three-dose immunization regimen among 9-16 year olds was 65.6% and in this age-group, vaccination reduced severe dengue by 93% and dengue hospitalizations by 82%.
An increased risk of hospitalized dengue was seen in the 2 to 5-year age group in Year 3 of follow-up.
At the time of SAGE April 2016 meeting, this increased risk was not observed in those aged 9 years and above.
Because of the higher efficacy of the vaccine against dengue and the absence of an observed increased risk of hospitalized dengue observed in older children, licensure of the vaccine was sought in 2015 with an indication of 9 years and above. Mathematical modelling suggested that the public health benefits of vaccination could be maximized if dengue seropositivity in the age group targeted for vaccination was high.
WHO issued its position on the use of CYD-TDV in July 2016 based on recommendations provided by SAGE in April 2016, principally, that countries interested in introducing the vaccine consider its use only in those aged 9 years and above, and in areas with a seroprevalence of ≥70%, and not in areas below 50%. SAGE noted that the evidence of the absence of a safety issue in seronegative individuals aged 9 and above was based on the limited data set of 10%-20% of the trial population, and highlighted the urgent need to better describe the long-term benefit-risk ratio of CYD-TDV in seronegative individuals.
On 29 November 2017, Sanofi Pasteur announced the results of additional studies to better describe the benefit-risk in seronegative individuals. This was made possible through the use of a newly developed NS1-based antibody assay applied to blood samples taken 13 months after vaccination to retrospectively infer dengue serostatus at time of first vaccination.
The new analyses from the long-term safety follow-up indicated that:
Overall population level benefit of vaccination remains favorable, but the vaccine performs differently in seropositive versus seronegative individuals.
Vaccine efficacy (VE) against virologically confirmed symptomatic dengue was high among inferred baseline seropositive participants ≥9 years of age: 76% (95%CI: 63.9, to 84.0), but much lower among baseline seronegative participants: 38.8% (95%CI: –0.9 to 62.9%) in the first 25 months after the first dose of vaccine.
There is an increased risk of hospitalized and severe dengue in seronegative individuals starting about 30 months after the first dose.
In areas of 70% dengue seroprevalence, over a 5-year follow-up, for every 4 severe cases prevented in seropositive, there would be one excess severe case in seronegative per 1,000 vaccinees; for every 13 hospitalizations prevented in seropositive vaccinees, there would be 1 excess hospitalization in seronegative vaccinees per 1,000 vaccinees.
In light of the new evidence on the long-term safety issue in seronegative individuals, balanced against the documented efficacy and safety in seropositive individuals, SAGE carefully considered two strategies: population seroprevalence criteria versus pre-vaccination screening. SAGE weighed up the feasibility of population seroprevalence studies and individual pre-vaccination screening, heterogeneity of seroprevalence between and within countries, potential vaccine coverage rates, public confidence in national vaccination programs, perceptions of ethical considerations with regard to population level benefit versus individual level risk, and communication issues.
SAGE acknowledged that currently both “population seroprevalence criteria” and “pre-vaccination screening” are programmatically difficult approaches for achieving high population protection from dengue.
Updated SAGE recommendations on the use of CYD-TDV (Dengvaxia®)
For countries considering vaccination as part of their dengue control program, a “pre-vaccination screening strategy” would be the preferred option, in which only dengue-seropositive persons are vaccinated.
Conventional serological testing for dengue virus IgG (e.g. dengue IgG ELISA) could be used to identify persons who have had previous dengue infections. Sensitivity and specificity of dengue IgG ELISA should be assessed in a local context, and will depend on the prevalence of other flaviviruses, and past use of flavivirus vaccines (such as Japanese encephalitis and yellow fever vaccines).
Currently available rapid diagnostic tests – despite their lower sensitivity and specificity to detect past dengue infection compared with conventional dengue IgG ELISA – could be considered in high transmission settings until better tests are available. In settings with high dengue transmission (high numbers of seropositives), a test with lower specificity might be acceptable.
The pre-test probability of an individual being seropositive will be higher in settings with high transmission. However, a pre-vaccination screening strategy may also be considered in low to moderate transmission settings. In settings with low transmission (high numbers of seronegatives) a test with high specificity is needed.
Given that no assay will be 100% specific, some truly seronegative individuals may be vaccinated due to a false positive test result. Furthermore, although the efficacy against dengue infections in seropositive individuals is high, it is still not complete. Hence, the limitations of CYD-TDV will need to be clearly communicated to populations offered vaccination.
There is a continued need to adhere to other disease preventive measures and to seek prompt medical care in the event of dengue-like symptoms, regardless of whether vaccinated or not. Vaccination should be considered as part of an integrated dengue prevention and control strategy together with well-executed and sustained vector control and the best evidence-based clinical care for all patients with dengue.
Decisions about implementing a “pre-vaccination screening” strategy with the currently available tests will require careful assessment at the country level, including consideration of the sensitivity and specificity of available tests and of local priorities, dengue epidemiology, country-specific dengue hospitalization rates, and affordability of both CYD-TDV and screening tests.
Whether there are age-specific effects, independent of serostatus, is the subject of ongoing research. Currently, the vaccine should be used within the indicated age range, which is typically 9 to 45 years of age. The age to target for vaccination depends on the dengue transmission intensity in a given country, and will be lower in countries with high transmission, and higher in countries with low transmission. The optimal age group to be targeted is the age at which severe dengue disease incidence is highest, and this can be ascertained from national and subnational routine hospital surveillance data.
In the absence of data on vaccine efficacy and safety with fewer than three doses, CYD-TDV is recommended as a three dose series given 6 months apart. Should a vaccine dose be delayed for any reason, it is not necessary to restart the course and the next dose in the series should be administered.
There are currently no data on the use of booster doses. Additional studies to determine the utility of a booster dose and its best timing are under way. Accordingly, there is no current recommendation for a booster dose.
Development of a highly sensitive and specific rapid diagnostic test to determine serostatus, and assessment of simplified immunization schedules and booster needs should be prioritized.