Dengue fever, a mosquito-transmitted viral infection, is common in over 120 countries around the world. Every year over 60 million people develop fever and joint pain from dengue, 18% of whom are sufficiently ill as to require hospitalization. Global deaths due to dengue are estimated at over 13,000.
Dengue is common in international travelers. It is one of the most common causes of fever in returned international travelers.
The incidence of dengue has increased 30-fold over the fifty years ending in 2010, due to urbanization, increased population, increased international travel, and global climate change.

The dengue vaccine Dengvaxia, approved by the FDA in 2019, has limitations. Recipients must:

1) be between 9-16 years of age
2) have laboratory confirmed prior infection with dengue
3) live in areas where dengue is common, that is, occurs frequently or continuously.

Hence it is not appropriate for the vast majority of travelers from the U.S.
Dengvaxia basics: 3 doses, 0, 6, 12 months. It protects for all four serotypes of dengue, with an efficacy of 80%. Protection lasts for at least six years.
A new dengue vaccine, Butantan DV, appears to be superior. Developed in Brazil, it is administered as a single dose. Like Dengvaxia, it protects against all four serotypes of dengue, and is 80% effective. An advantage over Dengvaxia is that administration does not require prior infection with dengue. In clinical trials, it was tested on people between the ages of 2 and 59.
However, it is still under investigation. Further studies will need to be conducted before it is approved by the FDA and available in the U.S.

So, currently, protection for dengue for most travelers consists of standard PPMs (personal protection measures): applying DEET or picaridin to exposed skin, applying permethrin to clothing, wearing long sleeves and pants, and sleeping under a mosquito net if sleeping quarters are not air-conditioned.

Chris Sanford, M.D.