Anti-Dengue IgG Seroprevalence and Exposure-Related Risk in Italian Military Personnel Deployed on Overseas Missions: A Cross-Sectional Study.

Dengue virus infection remains a significant public health challenge in endemic regions, with growing evidence of autochthonous transmission in Europe. Assessing serological exposure in high-risk populations such as military personnel deployed to endemic areas is essential to quantify exposure risk and support operational decision-making, particularly regarding pre-deployment counselling and risks associated with secondary infection. We conducted a cross-sectional study involving 1355 members of the Italian Armed Forces, measuring anti-dengue IgG antibodies by ELISA and collecting data on deployment history and exposure risk. Overall, IgG seropositivity was 8.12%, with significantly higher prevalence among individuals reporting travel or deployment to endemic regions (24.71%) compared with non-exposed personnel (4.27%). Seropositivity increased with age and correlated with a CDC-derived cumulative dengue risk score (Spearman's ρ = 0.299, p < 0.0001). A multivariable logistic regression model including age and exposure risk achieved an AUC of 0.75, while machine-learning models provided complementary predictive assessment, with random forest reaching an AUC of 0.79. These findings indicate substantial anti-dengue IgG seropositivity compatible with previous dengue exposure among Italian military personnel, particularly those deployed to endemic settings. The study highlights the need for targeted surveillance and risk-based preventive strategies, and supports the use of exposure-based models to improve epidemiological assessment and inform vaccination strategies in mobile populations.