Laboratory testing for dengue virus: interim guidance, April 2025

Overview

Dengue is a growing global public health concern, with incidence rising significantly over the past two decades and cases doubling annually since 2021. In December 2023, the World Health Organization (WHO) declared a global emergency to strengthen global response efforts. Accurate laboratory testing is essential for early detection, clinical management, outbreak control, and surveillance. Clinical diagnosis alone is insufficient due to symptom overlap with other diseases—making laboratory confirmation critical.

The wide range of available dengue diagnostic tests, including nucleic acid amplification tests, enzyme-linked immunosorbent assays, and rapid diagnostic tests, vary in performance and reliability, making test selection challenging, particularly in low-resource settings. Test choice should be guided by factors such as infection stage, sample type, regional prevalence, co-infections, prior exposure to dengue or other orthoflaviviruses, and vaccination status. As no universal diagnostic algorithm exists, testing strategies must be adapted to the local context.

This guidance synthesizes current evidence on dengue laboratory testing and diagnostics and provides practical recommendations for laboratories, clinicians, public health officials, and programme managers involved in dengue diagnosis, surveillance, and control, in the context of the global emergency. It includes a diagnostic algorithm for suspected cases, outlining appropriate testing methods based on days post symptom onset.