Global epidemiology of dengue in paediatric and adolescent populations: a systematic review and meta-analysis

Dengue infection is a major public health threat, especially to children.

To comprehensively summarise the global epidemiological evidence on dengue in paediatric and adolescent populations by reporting incidence proportions, seroprevalence by region, country, and age group, and presenting pooled odds ratio (OR) estimates between age, sex, and infection risk.

MEDLINE and Embase were searched until April 2024. This meta-analysis included studies reporting or allowing calculation of incidence proportion, seroprevalence, and ORs; pooled estimates were derived using random-effects models.

One-hundred fifty-eight articles were included. Incidence proportions were similar across the Americas, Africa, and Asia; country-specific incidence proportion was highest for Yemen (65%) and Brazil (53%). Seroprevalence was highest in Oceania and the Americas; country-specific seroprevalence was highest in Nicaragua (91%), and Honduras (88%). ORs of dengue infection did not differ between males and females [1.04 (95%CI: 0.95-1.14), p = 0.36]. However, dengue infection increased by age group with OR of 1.84 (95%CI: 1.51-2.24), p < 0.001 for children <10-years and 2.53 (95%CI: 2.03-3.16), p < 0.001 for those aged ≥10-years. The World Health Organisation's 2018 and 2024 position statements recommend CYD-TDV vaccination in countries where the seroprevalence reaches ≥80% and TAK-003 where it is ≥60% by nine years of age. However, our data indicate that no country meets the 80% threshold, and very few reach 60% seroprevalence by age 10.

Dengue infection affects youth globally across all endemic regions, with similar incidence distribution among continents. These findings illuminate the global and country-specific dengue epidemiology, emphasising the need for enhanced mitigation measures to reduce viral spread and impact.