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

## TL;DR

This paper reviews a century of dengue cases in military personnel, highlighting trends in incidence, diagnostics, and prevention to improve health policies and readiness.

## Contribution

The study provides a comprehensive systematic review of dengue in deployed military populations from 1905 to 2024, identifying gaps in prevention and diagnostics.

## Key findings

- There were 69,224 dengue cases reported in 42,272 military personnel across 41 deployment settings from 1904 to 2024.
- Diagnostic methods have evolved from clinical recognition to NS1 antigen and PCR tests.
- Prevention efforts are hindered by inconsistent use of vector control and low vaccine uptake.

## Abstract

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.