Dengue challenges

“Should I be worried?“ His 5-year-old son, his only child, started having a fever the night before the consultation. When asked about other signs and symptoms, he said that, along with the fever, he had an occasional cough. His wife shared that a lot of children in school have been experiencing colds, and he might have gotten it from there. There was no history of travel, nor was there anyone sick at home. His immunizations were all from the local health center until he was a year old, which meant he had yet to receive boosters and other recommended vaccines. After the physical examination, I sought to reassure him that I couldn’t find an obvious focus for the fever, and it would be best to sit tight. Noting the extremely worrisome look on his face, I asked him if he had other lingering questions. “Is it dengue?” I replied that it was too early to tell and took time to explain the possibilities. Management will be supportive, with paracetamol and a need to increase fluid intake. A list of what to observe and watch out for in the next few days was provided. Nearing the end of the consultation, his wife burst into tears, hugged her child tightly, and apologized for being emotional. There was no need; any doctor would understand.

“Ma’am, are you holding clinic today?” A colleague had brought in her two children, who eventually turned out to be positive for dengue. While she was more than competent, one can understand how objectivity can fly out the window when reality hits close to home. Luckily, their course was not complicated, despite one of them having a very atypical presentation.

Some points to highlight. Everyone can be vulnerable to dengue. Symptoms may be nonspecific. Dengue is possible as a differential diagnosis in the presence of fever, and its occurrence is not confined only to the rainy season.

Recently, the 2024 annual report of the Department of Health and the Research Institute of Tropical Medicine’s Department of Virology was shared in our group thread. This report was warmly welcomed by everyone in the medical community and is available on their website. Overall, it provides crucial data for outbreak response, current and future policymaking, and for us in practice, it serves as a solid reference for information on diseases of public health importance. Of the arboviruses, among the samples submitted from 2022 to 2024, there were zero cases detected by the laboratory for Zika. This, however, doesn’t apply to dengue and further demonstrates the gravity of the situation.

Of the 500,000 dengue cases and 750 deaths from the eight countries of the World Health Organization (WHO) Western Pacific Region, the Philippines was the most affected country, recording 167,355 cases and 575 deaths, with a case-fatality ratio (CFR) of 0.34 percent from Jan. 1 to Dec. 7, 2023. The CFR refers to the number of individuals who are diagnosed with dengue and die from it. While one may argue that it is within the WHO’s acceptable threshold of less than 1 percent, this number is reflective of the quality of clinical management and care, together with the severity of the disease. Molecular testing revealed that dengue virus serotype 2 (DENV-2) predominated from 2020 to 2022, shifting to dengue virus serotype 1 (DENV-1) in 2023 and 2024. Throughout the study periods, multiple serotypes were also found to be cocirculating.

You may ask why such data would matter. In the presence of dengue having four serotypes with no cross-immunity among the serotypes, the likelihood of having secondary and even sequential infections increases the risk for having more severe dengue and recurrent outbreaks.

In the latest update from WHO in 2024 (published in December 2025), globally, the recorded number of cases and deaths is said to have been unprecedented. This is concerning because it is a well-known fact that there may be substantial underreporting arising from several factors: from the nature of the disease, wherein the majority may be asymptomatic; the possibility of misdiagnosis because of the nonspecificity of symptoms; and the challenges in access to diagnostics.

In the last few weeks, alarm bells rang with reports of the Nipah virus. Not dismissive of its potential threat nor of the efforts that have been exerted toward addressing dengue with surveillance in place, I wonder what the tipping point would be for dengue to be a national priority when this has been a pestering problem for decades. In the absence of antiviral treatment, the lack of integrated preventive measures—as detailed by WHO, which include sustained vector control, community engagement, including a licensed vaccine—makes control, which, while more attainable than having zero deaths, remains an impossible dream.