Diagnostic and reporting opportunity in dengue: Dominican Republic, 2023–2024

Background: The speed at which a suspected dengue case receives care determines the diagnostic algorithm: nucleic acid amplification test (NAAT)/reverse transcription polymerase chain reaction (RT-PCR) or NS1 antigen within 0–7 days of symptom onset, and immunoglobulin M (IgM) serology after >7 days. Timely confirmation supports more accurate clinical classification, appropriate management, and a stronger surveillance response.
Objectives: To describe the time from symptom onset to care and its variation by year, type of institution, and clinical classification, to guide improvements in access, diagnosis, and reporting.
Methods: We conducted a cross-sectional analysis of harmonized national registries of confirmed dengue cases in 2023–2024 (n = 4,460). The main outcome was days between symptom onset and first care. Covariates included year, week/month, institution (public health system/SNS, private, other), clinical severity (no warning signs, warning signs, severe), type of care (outpatient, inpatient), age, sex, and province. We estimated medians and interquartile ranges, the distribution across delay bands (0–1, 2–3, 4–7, 8–30, >30 days), and temporal consistency (week of care ≥ week of onset). Analyses were descriptive using 2023– 2024 data.
Results: The median delay was 4 days in 2023 and 4 days in 2024. Overall, delays were distributed as follows: 0–1 days, 10.1%; 2–3 days, 35.0%; 4–7 days, 51.7%; 8–30 days, 3.1%; >30 days, ≈0.02%. Year-specific profiles were comparable (0–1 days: 10.5% in 2023 vs 9.1% in 2024; 4–7 days: 50.9% vs 53.5%). Weekly consistency was high (≈99.0% of records had week of care ≥ week of onset). By institution, the median delay was 3 days in private care and 4 days in the public health system. (All values derive from the 2023–2024 descriptive analysis; no causal inference is made.)
Conclusions: Most patients seek care within 0–7 days, enabling early virological testing (NAAT/RT-PCR/NS1) and supporting timely reporting. The 1-day difference between private and public care highlights opportunities to standardize early-demand counseling and strengthen primary care during seasonal peaks. We recommend institutionalizing a weekly, territorial timeliness dashboard and, when available, integrating test type (NS1/IgM/NAAT) to assess adherence to the diagnostic algorithm.