Unresolved questions in pediatric dengue: from disease mechanisms to prevention

Despite recent advances in understanding dengue infection, substantial gaps remain in its epidemiology, pathogenesis, diagnosis, and prevention, including vaccine development and its long-term impact. This review summarizes recent findings and highlights the most pressing research needs to advance the field and reduce individual and public health burden.

Dengue burden has increased, particularly among children and adolescents, and it has expanded into previously unaffected regions. Still, current data likely underestimates the true burden due to suboptimal surveillance systems. Improving control will require a better understanding of severe dengue pathogenesis, where key gaps remain, alongside reassessment of diagnostic limitations in the context of increasing vaccine availability. Vaccines represent an important complementary tool, with several candidates under study and two currently in use, each with distinct strengths, limitations, and unresolved questions.

More extensive research and investment are needed to address the growing burden of dengue, including severe outbreaks and geographic spread. Meanwhile, stronger regulatory engagement in the development and evaluation of innovative therapeutic and preventive measures is essential, particularly in low-income and middle-income regions that bear the highest burden. Clear communication and education on dengue, its impact, and available preventive measures proven to be well tolerated and effective are also critical to strengthen trust, improve uptake, and maximize public health impact.