Delays in Seeking Health Care among Patients with Dengue Recruited in a Sentinel Surveillance System in Puerto Rico before and after the COVID-19 Pandemic.

We evaluated health care-seeking behavior among dengue patients in Puerto Rico (PR) before (January 1, 2014-March 31, 2020) and after (April 1, 2020-February 28, 2023) the COVID-19 outbreak declaration in PR ("after COVID-19") and calculated age-adjusted odds ratios of illness duration at presentation and hospitalization rates. A total of 70 and 185 patients with dengue were identified before and after COVID-19 began respectively. Dengue virus 1 (DENV-1) was the most common dengue serotype (89%) identified in both periods. The median age of patients with dengue was higher after COVID-19 (18, interquartile range [IQR]: 12-32 years) than before (14, IQR: 7-22 years). A higher proportion of patients presented >3 days post illness onset after COVID-19 (66%, n = 123) in comparison with before (49%, n = 34) (OR = 1.16; 95% CI: 1.02-1.33). These findings indicate that the COVID-19 outbreak may have affected health care-seeking behavior among patients with dengue in PR, delaying care and potentially negatively affecting patient outcomes.