Key messages
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Vaccines are a well-researched method of preventing dengue. Most research focuses on whether the vaccines work and are safe. There is less information about how vaccines are offered to people and whether people's behaviour changes when they have been vaccinated.
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Other common areas of research are community education, such as teaching school children about mosquitoes, and changes to the environment, for example, removing areas where mosquitoes might live. Most of this research examines the effects of these methods on mosquitoes. Less research looks at the methods' effects on the spread of the disease.
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This evidence gap map highlights where evidence exists and where important critical gaps remain. Critical gaps include: understanding the type of people who were included in the studies; and how the various methods were used. We need more evidence in these areas to help people make decisions on preventing dengue.
What is dengue, and why is prevention important?
Dengue is a disease caused by a virus that is carried by a specific type of mosquito called 'Aedes'. Dengue spreads when these mosquitoes bite people. It causes flu-like symptoms, leading to more serious illness in about one in 20 people and sometimes even death. In 2023, there were over 6.5 million dengue cases and more than 7300 dengue-related deaths worldwide. Most people who get dengue live in low- and middle-income countries, where health systems may have few resources to prevent dengue. Dengue has spread recently, as a warming climate and changing rainfall patterns have created more areas in which mosquitoes can live.
What did we want to find out?
We wanted to find out what evidence about dengue prevention is available and where important gaps remain. Our goal was to map the evidence that is available for each method of preventing dengue, and see whether some methods and ways of measuring results have been studied more than others. This should tell us where to focus future research efforts to provide the right information for people working to prevent dengue. This evidence gap map does not aim to assess how well any method works.
What did we do?
We searched for evidence on dengue prevention. The evidence could be from ‘primary studies’, where new evidence is gathered directly from a source, for example by comparing two methods, or from ‘systematic reviews’, which combine and analyse the results from more than one primary study. We then mapped the evidence according to:
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the type of prevention method (for example, vaccines, community education, environmental management);
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what the evidence measured (effects on mosquitoes, spread of the disease, behavioural effects, how it was implemented, safety, costs);
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the study design; and
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the countries where the studies took place.
As our aim was to map the number and type of studies available, we did not assess how well the studies were designed and conducted, or how confident we could be in their results. However, where we found large reviews that summarised several studies, we rated our confidence in the evidence and assessed how useful the reviews could be for people making decisions about dengue control.
We asked doctors and people working to control dengue to help us:
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inform decisions about which prevention methods and measurements of impact to include;
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identify additional studies;
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ensure the gap map was usable and relevant; and
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prioritise gaps identified from the map.
What did we find?
We found 550 studies that took place in many different countries, mostly in low- and middle-income areas. We found that there were many more studies for some methods than others. The studies also measured different things. For example, some looked at the number of people getting dengue and some looked at changes in behaviour.
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Vaccines were a commonly researched method, with 99 studies and 4 reviews, mainly focusing on how well the vaccines worked and if they were safe.
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Other methods — particularly community education (187 studies) and environmental management (83 studies) — were mostly assessed by studies measuring effects on mosquitoes or changes in people's behaviour, with far fewer assessing dengue cases, severe disease, or implementation outcomes (these are measures relating to how much and how well a method is use).
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Very few of the studies about interventions other than vaccines measured harms or costs, limiting the relevance of the evidence for real-world programme planning.
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Useful evidence summaries were available for some methods but not for others. We found several reviews of some methods (e.g. vaccines) but other methods only had outdated or low-quality reviews, even though the methods had been tested in many research studies.
What are the limitations of the evidence?
The studies did not give much information about the types of people they included or how the different methods were used. This limits our ability to understand how well current research addresses unfair differences in the health of different groups of people (health inequities) and to support government decisions about dengue control in different parts of the world.
How up to date is this evidence?
The evidence is up to date to August 2025.
閱讀完整摘要
Dengue remains a pressing global health challenge, particularly in low- and middle-income countries (LMIC). Despite a growing volume of research on prevention strategies, there is a notable lack of consolidated, high-level research capturing the full scope of existing knowledge. The current evidence landscape is fragmented, with studies varying widely in design, focus, and quality. A structured map that includes both primary studies and systematic reviews is urgently needed. Such evidence and gap maps (EGMs) serve as a decision-support tool for funders, policymakers, and researchers by identifying where research exists and where future investments are most needed.
目的
To:
1. comprehensively identify the published literature on dengue prevention strategies;
2. critically appraise systematic reviews;
3. present the findings of objectives 1 and 2 in a single evidence gap map; and
4. identify critical knowledge gaps to inform future primary studies and systematic reviews.
搜尋策略
We searched MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR) in the Cochrane Library, and LILACS (BIREME) on 6 August 2025. We did not apply any date or language restrictions to the searches.
選擇標準
We included randomised controlled trials (RCTs), quasi-randomised trials, non-randomised studies of interventions (NRSIs) and systematic reviews. NRSIs had to have a comparator. We included study designs such as cohort studies, interrupted time series designs, controlled before-after studies, and case-control studies. We did not include case studies or animal studies conducted in a laboratory or semi-field environment. We did not have any restrictions on date or language of publication.
We included studies that compared dengue prevention strategies against placebo, no intervention, or usual care.
We developed intervention and outcomes categories through a structured stakeholder engagement process and an existing theoretical framework.
資料收集與分析
We used Cochrane Crowd, Cochrane's citizen science platform designed to host classification tasks, to help identify and describe health-related research. The results collectively identified by the Crowd as being potentially relevant to the EGM were then imported into EPPI Reviewer for further assessment and coding by the author team.
Two review authors independently extracted data from the included studies using a structured coding framework developed during the pilot stage.
Following coding, we exported data from EPPI Reviewer to EPPI Mapper to generate an interactive, online map that visually displays the distribution of evidence and identifies key gaps by intervention and outcome.
We sought to identify evidence and map it, but did not seek to provide a critical appraisal of that evidence. However, to support systematic review teams in understanding where there are evidence synthesis gaps, and to minimise research duplication, we decided to critically appraise the systematic reviews. Two review authors independently appraised the quality of systematic reviews, using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2).
We partnered with Instituto Veredas, a Brazilian non-governmental organisation, that aims to build bridges between public management, academia, and civil society, to conduct stakeholder engagement.
主要結果
The searches identified 20,355 records. After deduplication, we screened 16,468 titles and abstracts, then assessed 720 full-text articles for further eligibility. In total, we included 550 studies in the EGM.
Evidence from primary studies
We included a total of 505 primary studies, comprising 197 RCTs and 308 NRSIs, with 219 published in the past decade. Most studies were conducted at the community level with mixed adult and child populations, predominantly in high-prevalence regions of South America and South Asia. Brazil accounted for the largest share of studies (64 studies), and Aedes aegypti was the most frequently targeted vector species.
Of our five main intervention domains (vaccines, environmental, community education, targetting of aquatic stages of the vector and targetting of adult vectors), community education was the most extensively studied (47 RCTs and 140 NRSIs), largely focusing on behavioural and entomological outcomes. These interventions overlapped with vector control interventions targeting both aquatic and adult stages of the mosquito.
Evidence from systematic reviews
We included 45 systematic reviews. We rated only eight as high or moderate quality using the AMSTAR 2 tool, with the majority classified as low or critically low quality due to methodological weaknesses. Common deficiencies included lack of protocol registration, inadequate justification for study exclusions, and insufficient consideration of risk of bias in interpreting findings. Of the eight high- or moderate-quality reviews, most of which evaluated multiple interventions, two included environmental interventions, three evaluated community education, four assessed vaccines, one evaluated vector control interventions exclusively targeting aquatic stages, and three included vector control of adult mosquitoes.
Key gaps
For community education, a clear gap exists for implementation outcomes, where the substantial evidence base of 25 primary studies has not been synthesised by any high- or moderate-quality systematic reviews. Adult vector interventions present multiple synthesis gaps despite extensive primary studies, as existing reviews are outdated or restricted to Wolbachia-infected mosquitoes. Aquatic-stage interventions show consistent synthesis gaps across all outcome domains. For vaccines, evidence is particularly limited for implementation outcomes and entirely absent for behavioural outcomes, indicating minimal evidence in these domains. Finally, environmental interventions display synthesis gaps for behavioural and implementation outcomes, where primary studies are available but high- or moderate-quality systematic reviews are lacking.
作者結論
The primary challenge in the dengue prevention evidence base is not the absence of studies, but the lack of strategic synthesis aligned with decision-making needs. Priority areas for future research include:
• updated and comprehensive systematic reviews for adult and aquatic-stage vector interventions;
• synthesis of implementation and behavioural evidence across all non-vaccine interventions; and
• systematic evaluation of adverse effects beyond vaccine technologies.
From a policy perspective, reliance on entomological outcomes alone remains insufficient. Greater emphasis on epidemiological and implementation outcomes is essential to support effective, scalable, and context-sensitive dengue control strategies. Aligning future research agendas with these gaps may substantially enhance the usability of the evidence for public health decision-making, particularly in endemic and resource-constrained settings.
經費
The Cochrane Collaboration funded stakeholder engagement work, information specialist expertise, and some of the authors.
登記
Protocol (2025): DOI: 10.1002/14651858.CD016299
