Global determinants of dengue vaccine acceptance: An updated systematic review and meta-analysis.

OBJECTIVE

To systematically review and quantify the key determinants influencing dengue vaccine acceptance in populations where the vaccine is recommended or considered.

STUDY

DESIGN

Systematic review and meta-analysis.

METHODS

Comprehensive searches were performed in PubMed, Web of Science, Global Index Medicus, and Google Scholar, without date restrictions through April 2026. Eligible studies reported quantitative effect estimates of factors associated with dengue vaccine acceptance. Random-effects inverse-variance models with Hartung-Knapp adjustment, and heterogeneity with I2 statistic were applied. Analyses were stratified by pediatric and adult populations, with subgroup analyses and meta-regression conducted for determinants with substantial heterogeneity.

RESULTS

A total of 775 records were identified, with 18 studies meeting inclusion criteria (15 included in quantitative synthesis). In pediatrics, a positive attitude toward vaccination was linked with higher acceptance (OR: 5.66, 95% CI: 2.74-11.7; I2 = 0%), although evidence for other determinants remained inconclusive. In adults, prior dengue infection (OR: 1.47, 95% CI: 1.36-1.60; I2 = 0%), prior influenza vaccination (OR: 2.66, 95% CI: 1.61-4.38; I2 = 70.2%), and positive vaccine attitudes (OR: 2.84, 95% CI: 1.05-7.70; I2 = 98.4%) were associated with higher acceptance; however, substantial heterogeneity and low certainty of evidence limited confidence in pooled estimates.

CONCLUSION

Dengue vaccine acceptance may be influenced more by attitudes and prior experiences than by demographic factors alone; however, substantial heterogeneity, reliance on cross-sectional evidence, and very low certainty ratings limit confidence in these findings. Public health strategies should prioritize strengthening vaccine confidence, enhancing risk perception among dengue-naïve populations, and leveraging prior vaccination behaviors, while addressing structural barriers to ensure equitable access.