Dengue in deployed military personnel, 1905-2024: a systematic review of incidence, diagnostics and prevention

Military deployments to dengue-endemic regions present ongoing risks to health and mission readiness. This review synthesizes a century of evidence on the incidence, clinical features, diagnostics and prevention of dengue in military personnel, aiming to guide future health policies, research and Force Health Protection strategies.

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a search of PubMed and Google Scholar (March 15-April 5, 2025) identified 32 English-language studies (1905-2024) reporting primary data on dengue in military personnel. Studies were selected based on predefined criteria and narratively synthesized.

A review of 32 studies involving 42 272 military personnel across 41 deployment settings identified 69 224 dengue cases, with outbreaks dating back to 1904. A notable spike occurred between 2012 and 2017, likely due to increased deployments to endemic regions and better surveillance. Diagnostic methods have advanced from early clinical recognition to modern Non-structural Protein 1 (NS1) antigen and Polymerase Chain Reaction (PCR) tests. Common symptoms included high fever, intense headache and myalgia. Despite efforts such as integrated vector control and Personal Protective Measures (PPMs), and new vaccines (Qdenga®, Takeda), prevention remains limited by inconsistent use of integrated vector control and PPMs, low vaccine uptake and eligibility constraints.

Dengue continues to threaten operational readiness in tropical deployments. Strengthening integrated vector control, PPMs, vaccination and real-time surveillance is crucial to reduce its impact and control other co-endemic diseases like malaria, yellow fever, chikungunya and Zika. Future research should focus on evaluating integrated vaccine and vector control strategies aimed at enhancing Force Health Protection among military personnel.