This indicator measures the impact of the appropriate use of regional clinical management guidance on reducing preventable deaths from dengue in the context of co-circulation of other arboviruses. 

During the period of the Strategic Plan, the Region faced a severe dengue epidemic. Nonetheless, since 2016 the case fatality rate has been at or below the 2025 target of 0.050% on numerous occasions, including in 2025. Overall, the regional trend in dengue case-fatality has been downward, remaining at or below 0.05%. This indicator has therefore been achieved. However, as expected for an epidemic-prone disease such as dengue, the case-fatality rate tends to increase during large-scale outbreaks.

The overall decline reflects improvements in the clinical management of dengue at all levels of care, from primary health care through timely identification of the disease and its warning signs to prevent progression to severe forms, to hospital and intensive care services. During large-scale epidemics, health services often become overloaded due to the high influx of patients. This is one of the main factors associated with increased dengue-related deaths in the Region, as overcrowding in health facilities can result in inadequate patient monitoring. 

With support from PAHO, countries continue to strengthen technical capacities for the clinical management of dengue and other arboviral diseases. The bundle of interventions available at the regional level includes updated clinical guidelines, a continuing education program, and the establishment of networks of clinical experts in arboviral diseases at the regional and national levels. The Region now has updated, evidence-based clinical guidelines for the diagnosis and treatment of dengue, chikungunya, and Zika, as well as regional guidelines for the management of severe dengue in intensive care units that are the first available at the global level, developed in collaboration with the Pan American and Iberian Federation of Critical Medicine and Intensive Therapy. 

Through PAHO’s Virtual Campus for Public Health, more than 798 000 health professionals have been trained in the clinical management of dengue since September 2020. In addition, 13 countries have established national networks of clinical experts in dengue and other arboviral diseases which, under the direct coordination of national health authorities, implement continuing education programs down to the local level. 

All of these actions are being implemented within the framework of the Integrated Management Strategy for Arboviral Disease Prevention and Control in the Americas (IMS-Arbovirus), which was updated in 2025 and will be presented to the 63rd Directing Council.