approved for use by Mexico, Brazil, El Salvador, Costa Rica, Singapore, Paraguay, much of Europe, and the United States. The vaccine is only recommended in individuals who have had a prior dengue infection or in populations where most (>80%) of people have been infected by age 9. In those who have not had a prior infection there is evidence it may worsen subsequent infections. For this reason Prescrire does not see it as suitable for wide scale immunization, even in areas where the disease is common. The vaccine is produced by Sanofi and goes by the brand name Dengvaxia. It is based on a weakened combination of the yellow fever virus and each of the four dengue serotypes. Studies of the vaccine found it was 66% effective and prevented more than 80 to 90% of severe cases. This is less than wished for by some. In Indonesia it costs about US$207 for the recommended three doses. Given the limitations of the current vaccine, research on vaccines continues, and the fifth serotype may be factored in. One of the concerns is that a vaccine could increase the risk of severe disease through antibody-dependent enhancement (ADE). The ideal vaccine is safe, effective after one or two injections, covers all serotypes, does not contribute to ADE, is easily transported and stored, and is both affordable and cost-effective. Anti-dengue day International Anti-Dengue Day is observed every year on 15 June. The idea was first agreed upon in 2010 with the first event held in Jakarta, Indonesia, in 2011. Further events were held in 2012 in Yangon, Myanmar, and in 2013 in Vietnam. Goals are to increase public awareness about dengue, mobilize resources for its prevention and control and, to demonstrate the Southeast Asian region's commitment in tackling the disease. Management There are no specific antiviral drugs for dengue; however, maintaining proper fluid balance is important. Treatment depends on the symptoms. Those who can drink, are passing urine, have no "warning signs" and are otherwise healthy can be managed at home with daily follow-up and oral rehydration therapy. Those who have other health problems, have "warning signs", or cannot manage regular follow-up should be cared for in hospital. In those with severe dengue care should be provided in an area where there is access to an intensive care unit. Intravenous hydration, if required, is typically only needed for one or two days. In children with