Community participation and clinical response: the strategy that helped reduce dengue cases in five countries

With support from the European Commission’s Directorate-General for European Civil Protection and Humanitarian Aid Operations (ECHO) and PAHO, Bolivia, Guatemala, Honduras, Panama, and Paraguay strengthened surveillance, clinical care, and community participation, helping to contain the epidemic.

— December 2025 —

A year ago, Bolivia faced a significant increase in dengue cases, setting off alarms among health authorities. The country began assessing how to intensify epidemiological surveillance and strengthen clinical management to contain an epidemic that had reached nearly 59,000 cases in 2024.

As an immediate response, the Pan American Health Organization (PAHO) worked with authorities to design a strategy to strengthen clinical care. More than 200 health professionals — including intensivists and second- and third-level hospital teams — received training to improve the country’s capacity for timely detection, and accurate classification and treatment of patients with dengue, which can be fatal in its severe form.

The first step was to identify clinical leaders in dengue to form the National Network of Clinical Experts, made up of frontline health personnel treating patients with suspected illness. Priorities were then defined, and training sessions were carried out in various parts of the country, mainly in Santa Cruz, the department with the highest transmission. These activities made it possible to standardize, update, and strengthen knowledge on the diagnosis, classification, and treatment of dengue.

“Management of dengue patients has been optimized to standardize care from a higher-complexity hospital to a first-level center or a medical post,” explained Dr. Eliana Vega of the French Hospital in Santa Cruz, Bolivia.

For families, the strengthening of clinical care also made a tangible difference. Amalet Angulo, mother of Jaime Manuel, who was hospitalized with dengue at the French Hospital of Santa Cruz, recalls the relief she felt upon arriving at the health facility: “When you go to the doctor, it gives you confidence and you feel safe arriving at a place where you know they are trained to take care of you, because you’re not bringing just anyone, you’re bringing your child.”

Her son, Jaime Manuel, who at first did not understand the severity of the disease, changed his mind when he was admitted to intensive care: “When someone goes to intensive care, it’s because they’re very sick, and I wondered how serious this could be. When I got to intensive care, I was the only one awake because the others were intubated,” he recounts.

A regional and coordinated response

The actions in Bolivia were part of a broader response to the dengue outbreak that PAHO implemented in five countries with funding from the European Union. In addition to Bolivia, the project included Guatemala, Honduras, Panama, and Paraguay.

The Region of the Americas experienced the largest dengue epidemic since official records began in 1980. In 2023, more than 4.5 million cases were reported — reaching a historic record — but in 2024 the number tripled, surpassing 13 million cases, with more than 23,000 severe cases and 8,400 deaths.

Although 90% of cases were concentrated in Brazil, the project’s focal countries recorded some of the highest incidence rates in the region. In Central America, Guatemala (188,585 cases), Honduras (177,209), and Panama (37,231) accounted for 36% of the subregional cases. In the Southern Cone, Bolivia and Paraguay reported 346,224 suspected cases, 85% of which occurred in Paraguay.

Dengue has four serotypes, and when a new one circulates in a population, many people lack immunity and can become infected at the same time. Those who have previously had dengue are also at higher risk of severe illness if they contract a different serotype. Together, these factors drive surges in cases and place heavy strain on health systems. In Central America, the recent rise in dengue was fueled by warm, rainy conditions and further intensified by the reemergence of dengue serotype 3 (DENV-3) after more than a decade of low circulation. This serotype alone accounted for over 80% of detected cases.

In Bolivia and Paraguay, updated risk assessments and entomological surveillance data were used to anticipate the period of highest transmission, especially given the possibility of DENV-3 reappearing in a region where DENV-2 had predominated in recent years.

Because the two subregions were in different phases of the annual dengue transmission cycle, project activities adopted different approaches: Central American countries focused on timely, high-quality care during the high-transmission phase, while South American countries prioritized early preparedness for the upcoming season. In all five countries, PAHO worked with ministries of health to strengthen long-term capacities and incorporate these improvements into routine public health practice.

Strengthening the capacities of health teams contributed to mitigating the epidemic. More than 31,800 professionals were trained in clinical management of dengue, and more than 22,000 in vector surveillance and control, through both in-person and virtual modalities. In addition, the project supported the development of the first global guidelines for managing severe dengue in intensive care units.

“No one should die from dengue. We have the tools and the knowledge to detect sever dengue, treat it, and save lives,” said Sylvain Aldighieri, Director of the Department of Prevention, Control and Elimination of Communicable Diseases at PAHO. “The magnitude of this epidemic has shown that the response to dengue requires coordinated intra- and intersectoral action at all levels,” he added.

As a result of this effort, the countries made progress in strengthening their public health systems, incorporating lasting improvements into their response strategies. Improvements include stronger national epidemiological surveillance rooms to improve monitoring and evidence-based decision-making, integrated clinical expert networks to provide remote support, and supplying essential materials and diagnostic tools to local health services.

At the project’s close in April 2025, the five countries had recorded an average 70% reduction in new dengue cases compared with the average of the previous five years. While this decrease is due to multiple factors, the measures implemented helped strengthen national capacities in surveillance, clinical management, and vector control, supporting ministries of health in mitigating the epidemic’s impact.

In 2024, dengue epidemics were reported in 23 countries in the region, reaching the historic figure of more than 13 million cases in a single year. PAHO estimates that nearly 500 million people in the region are currently at risk of contracting the disease. Together with its partners, PAHO continues working to improve preparedness, build stronger health systems, and promote responses that integrate health and the environment, protecting communities from future dengue outbreaks.

Paraguay: Strengthening health personnel

With PAHO’s support, more than 600 health professionals in Paraguay were trained in diagnosis and clinical management of dengue. In addition, specialized medical equipment was provided, including 500 pediatric sphygmomanometers, to improve timely care for children with dengue.

In the city of Encarnación, Paraguay, an educational puppet show was developed for primary school children to teach them the importance of eliminating mosquito breeding sites. As agents of change, the children bring prevention messages to their homes and communities.

The show, presented in different schools across the country, turned learning into a playful experience that fosters environmental and health awareness to control Aedes aegypti from early stages.

Panama: Mosquito hunters

The Mosquito Hunters Brigade, supported by PAHO and led by the Ministry of Health of Panama, engaged students and communities in the fight against dengue, Zika, and chikungunya. The program encouraged the formation of school brigades responsible for identifying and eliminating mosquito breeding sites in homes, schools, and community environments through educational and preventive actions.

Dengue