Why expanding access to accurate dengue tests is a critical need in Asia

The viral infection known as dengue is an increasing public health threat. In 2024, the World Health Organisation received reports of 14.6 million cases of this mosquito-borne virus – a historic high, with infections endemic in more than 100 countries [1]. That number is presumed to be a significant undercount; experts estimate that there are between 100 million and 400 million dengue infections every year [1].

Dengue is a major and growing global health threat, now endemic in more countries than ever before, primarily affecting tropical and sub-tropical climates [1, 2]. Yet, the severity of the threat is often underestimated because many infected patients experience no symptoms or only mild ones – such as high fever, headache, pain in the joints and muscles, nausea, vomiting, and a rash [2].

This initial mild presentation makes the disease particularly dangerous because dengue virus can occasionally cause severe disease and even death [1]. The risk of severe disease is greater in people infected by dengue more than once (secondary infection) [1, 2]. Severe dengue includes dengue hemorrhagic fever or dengue shock syndrome [2] and can lead to complications such as internal bleeding, organ damage, shock which can be fatal [2]. These symptoms of severe dengue may include severe abdominal pain, persistent vomiting, bleeding in the gums or nose, blood in vomit, urine or stools, heavy menstrual bleeding, lethargy or change in alertness, and breathlessness – indicating a potentially life-threatening complication [1, 3].

The global cost of this severity is high; in 2024, the WHO recorded nearly 12,000 deaths related to dengue [1]. Since dengue is diagnosed in only a fraction of infected individuals, most patients are unlikely to know whether they have been infected before, obscuring their potential risk for severe disease in the future.

As a healthcare threat, dengue is persistent in Asia, with varying levels of endemicity across the region. According to reported data, the Philippines, Vietnam, Indonesia, Thailand, India, and Malaysia have some of the highest infection prevalence rates in the region, although for countries like India and Indonesia the global burden of disease estimates are much higher [4]. Thus, underreporting appears to be an issue that falsely depicts disease burden, leading to underestimation of the prevalence [4]. Furthermore, Asia has the highest case fatality rates (CFRs) across all seven continents [5].

Rapid diagnosis and test access

While there is no cure for dengue, effective prevention and control measures include rapid diagnosis, preventing mosquito bites and control of mosquito population [2]. Rapid detection allows public health teams to implement outbreak measures quickly to prevent spread within a community [6]. WHO has also found that access to medical care when cases are detected early can reduce the fatality rate of severe dengue to less than 1% [1, 7].

Dengue infection is primarily diagnosed in the laboratory by detecting the virus through the NS1 antigen and the host’s antibodies – IgM and IgG – depending on the phase of the illness [8, 9]. The most widely used testing technologies in Asia include ELISA and rapid diagnostic tests [9]. According to the report of the 2025 Advancing Diagnostics Roundtable convened at the sidelines of the Asia Dengue Summit and conducted by Vista Health, while RT-PCR tests are typically more accurate and sensitive, their use is generally limited to national public health laboratories for surveillance purposes, due to their high pricing and long turnaround time [10].

Unfortunately, there are many barriers to accessing dengue diagnostic tests. The report revealed turnaround times for these tests vary widely; countries including Indonesia, Malaysia, and Singapore often deliver results faster than others [10]. In addition, health systems may lack the training needed to run dengue tests, and inefficient workflows limit the number of labs willing to offer them [10]. Diagnostic performance varies across dengue tests [8]. Inconsistent specificity and sensitivity across these tests reduce their adoption [10].

Direct patient access to tests is also a challenge, as highlighted in the report [10]. In India and Thailand, for example, diagnostic and patient care access are heavily centralised, limiting access at the community level [10]. In other countries, diagnostics are available at the community level: barangays (public community primary healthcare facilities in the Philippines); puskesmas (public community health clinics in Indonesia); klinik kesihatan (public community health clinics in Malaysia); and general practitioner clinics in Singapore [10].

Beyond cost, economic differences and the capacity of existing laboratory infrastructure are also key factors affecting access to dengue diagnostics. High-income countries such as Singapore are more likely to adopt advanced diagnostics and invest in innovation [10]. Upper-middle-income countries – like Malaysia, Indonesia, and Thailand – have strong laboratory networks, but access beyond urban areas is limited [10]. Lower-middle-income countries, including the Philippines and Vietnam, rely heavily on rapid diagnostic tests with limited lab infrastructure available [10].

Recommendations for improvement

Fortunately, experts in diagnostics and public health at the Advancing Diagnostics Roundtable offered several recommendations that could expand access to rapid dengue testing in Asian countries. For example, countries may build on cross-border collaborations and pooled procurement to reduce diagnostic costs and improve supply chain efficiency [10]. This would require formalising partnerships among countries and sharing cost/benefit data for various test types [10].

Training and education are other areas where changes could improve outcomes. Integrating diagnostic education into medical school curricula and continuing medical education programmes could help practitioners get up to speed about what’s available and how to use dengue tests [10]. Online classes or workshops could also help with this, as would updating national guidelines to integrate recommended diagnostic workflows and testing algorithms [10].

Finally, engaging stakeholders can be a powerful step. Establishing partnerships with national reference labs and research institutes can support test validation, training, and broader rollout of diagnostics, while teaming up with academic societies and advocacy groups can help raise awareness of the value of diagnostics alongside vaccination and surveillance programmes. Alongside those, setting up public-private partnerships can also support wider distribution of key tests [10].

Looking ahead

Expanding access to rapid, reliable dengue diagnostic tests is important and feasible – but it won’t be easy. Public health officials and clinical laboratory teams alike will have to overcome skilled personnel shortages, infrastructure and equipment limitations, regulatory and policy hurdles, and an overall lack of awareness of the value of early detection. However, by working together and aligning on key goals, it should be possible to raise awareness of the need for tests, increase training among medical and laboratory professionals.

Note: Insights referenced from the 2025 Advancing Diagnostics Roundtable Report represent participating experts’ opinions.

References:

[1] World Health Organization (2025). Dengue (Fact sheet). Available at: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue (Accessed: 13 October 2025).

[2] Mayo Clinic (2024). Dengue fever: Symptoms and causes. Available at: https://www.mayoclinic.org/diseases-conditions/dengue-fever/symptoms-causes/syc-20353078 (Accessed: 5 December 2025).

[3] National Centre for Infectious Diseases (NCID) (2025). What are the warning signs of severe dengue infection? Available at: https://www.ncid.sg/News-Events/News/Pages/What-are-the-warning-signs-of-severe-dengue-infection.aspx (Accessed: 5 December 2025).

[4] Lee, S.Y. et al. Discrepancies in dengue burden estimates: a comparative analysis of reported cases and global burden of disease study, 2010–2019. J Travel Med 2024;31(4). doi: 10.1093/jtm/taae069. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11149719/.

[5] Haider, N. et al. (2025) ‘Global dengue epidemic worsens with record 14 million cases and 9000 deaths reported in 2024’, International Journal of Infectious Diseases, 158, p. 107940. doi:10.1016/j.ijid.2025.107940.

[6] Hunsperger EA, et al. Use of a Rapid Test for Diagnosis of Dengue during Suspected Dengue Outbreaks in Resource-Limited Regions. J Clin Microbiol. 2016;54(8):2090-5. doi: 10.1128/JCM.00521-16. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4963516/

[7] World Health Organization (2009). Dengue: guidelines for diagnosis, treatment, prevention and control. New ed. Geneva: World Health Organization.

[8] World Health Organization (2025). Laboratory testing for dengue virus: interim guidance, April 2025. Available at:  https://www.who.int/publications/i/item/B09394 (Accessed: 5 December 2025).

[9] Grand View Research (2025). Dengue Testing Market Size & Share | Industry Report, 2030. Available at: https://www.grandviewresearch.com/industry-analysis/dengue-testing-market-report (Accessed: 13 October 2025).

[10] Vista Health Pte Ltd (2025). Advancing Diagnostics Roundtable at the Asia Dengue Summit Report. PowerPoint presentation, 15 June.