A PRIME, PROTECT, AND PREVAIL: DO SINGLE-DOSE CHIKUNGUYA VACCINES PERFORM AS WELL AS TWO-DOSE REGIMENS? : SYSTEMATIC REVIEW AND META-ANALYSIS
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Abstract
Prime, Protect, and Prevail: Do Single-Dose Chikungunya Vaccines Perform as Well as Two-Dose Regimens? : A Systematic Review and Meta-Analysis
Introduction:
Chikungunya is a mosquito-borne viral disease causing significant morbidity in tropical and subtropical regions. Recent vaccine development includes both single-dose and two-dose regimens; however, no direct head-to-head comparisons exist. This study aims to compare their immunogenicity and safety through an indirect meta-analysis.
Methods:
A systematic review and meta-analysis of randomised controlled trials (phase 1–3) were conducted. Adults receiving single-dose or two-dose chikungunya vaccines versus placebo were included. Primary outcomes were seroresponse and adverse events. Pooled risk ratios (risk ratio [RR]) with 95% confidence intervals (confidence interval [CI]) were calculated using fixed- and random-effects models, with heterogeneity assessed using I² statistics.
Results:
Single-dose vaccines demonstrated significantly higher seroresponse compared to controls (RR 89.43; 95% CI 38.95–205.31; p < 0.0001) with no heterogeneity (I² = 0%). Adverse events were more frequent (RR 2.10; 95% CI 1.04–4.22; p = 0.038) but consistent across studies. Subgroup analysis showed higher seroresponse in single-dose regimens (98.0%; 95% CI 96.9–98.8; I² = 21%) compared to two-dose regimens (70.8%; 95% CI 34.0–91.9; I² = 97.2), with significant differences (p = 0.0003). Overall pooled seroresponse was 92.3% with very high heterogeneity (I² = 99.1%), likely reflecting differences in trial phases and vaccine platforms.
Conclusion:
Single-dose chikungunya vaccines demonstrate superior immunogenicity and a favourable risk–benefit profile compared to two-dose regimens. They offer a practical strategy for rapid immunisation in endemic and resource-limited settings. However, findings should be interpreted cautiously due to indirect comparisons and high heterogeneity. Direct head-to-head trials are required.
Keywords: chikungunya vaccine, immunogenicity, meta-analysis, safety outcomes, seroresponse
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