Dengue and aging: challenges and opportunities in prevention and care. A narrative review

Dengue infection is a global health issue with significantly increased incidence and overall burden, especially since 2024. Specifically, epidemiological trends show a rising median age of affected individuals over 65 years/old. Older individuals face increased risks of severe disease, extended hospital stays, healthcare-associated infections, and higher mortality rates, mainly due to a decline in immune function, and multimorbidity. Antibody-dependent enhancement, cytokine dysregulation, and endothelial dysfunction exacerbate disease severity. Moreover, in older patients, dengue diagnosis can be difficult, due to atypical symptoms. To date, there are no specific prognostic markers and no specific antiviral drugs. Management requires age-specific considerations. Evidence on immunomodulatory and antiviral therapies is emerging, and vaccine efficacy and safety data in older adults remain limited, despite growing interest. With an aging global population, dengue represents an urgent clinical challenge: there is an unmet and increasing need for comprehensive, practical guidelines to help clinicians in the diagnosis, treatment, prevention, and control of dengue infection in older patients.