by Alemany A, Mourão MP, Mohamed AFBS, Loon SLC, Zakaria ZHB, de Oliveira AA, Zain RM, Sosa-Estani S, Barral-Netto M, Freitas MS, de Lacerda MVG, Bassat Q, Karthikeyan G, Auewarakul P, Ngah NF, Ribeiro I, Siqueira AM, Teixeira MM, Boaventura VS, Dengue Alliance Clinical Experts Meeting Group. Open Forum Infectious Diseases 2026;13(10):ofag565.doi:10.1093/ofid/ofag565
Summary: Arboviral diseases represent an escalating global health threat, yet therapeutic development has been markedly slower than for other viral illnesses. Key barriers include the unpredictability and variability of arbovirus transmission, which complicates site selection, limit recruitment, and increases delays and the risk of inconclusive trials. Additional challenges include maintaining trial-ready sites, recruitment within the narrow therapeutic window, ensuring rapid diagnostics, and including high-risk groups. To address these barriers, the authors of this manuscript propose several strategies based on a clinical experts meeting convened by the Dengue Alliance. These include pre-activated trial networks for rapid initiation during outbreaks; early-warning surveillance to guide geographic activation; decentralized trial models; platform trial designs; and participant inclusion based on clinical syndrome supported by rapid diagnostics.
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