Emerging Insights into Dengue Pathogenesis in India and Interaction with Immunity, Microbiota, and Vector Ecology

Dengue virus (DENV), comprising four well-established serotypes (DENV 1 to DENV 4) and a potential fifth serotype (DENV 5, first reported in Malaysia in 2013 and has not yet been detected in India as of 2025), remains a major global health concern. It causes dengue fever (DF) and, in severe cases, dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS). Primarily transmitted by Aedes aegypti and Aedes albopictus, dengue is endemic in over 100 countries, with the World Health Organization (WHO) estimating 100 to 400 million infections annually. India bears a significant portion of this burden due to rapid urbanization, climate change, inadequate vector control, and people’s mobility. The review study explores viral pathogenesis, serotype diversity, host immune responses, microbiota influences, and how nutritional factors like obesity may influence disease severity. Recent advances in emerging tools such as biomarkers, vector genome research, microbiome, and techniques like the Sterile Insect Technique (SIT) and Wolbachia interventions offer promising directions for disease mitigation. However, persistent challenges, underreporting, limited vaccine access, and vector adaptation continue to challenge dengue control efforts in India, highlighting the need for an integrated, evidence-based strategy.