A Clinical and Operational Preparedness Framework for Dengue in Colombia: Integrating Surveillance, Clinical Response, Prevention, and Health System Planning.

Dengue is an arboviral disease of major public health relevance in Colombia, where recurrent endemic-epidemic transmission intersects with climatic variability, urbanization, population mobility, co-circulation of viral serotypes and lineages, seasonal healthcare pressure, and substantial direct and indirect costs. Although dengue prevention and response in Colombia include epidemiological surveillance, clinical diagnosis, management of warning signs, vector-control activities, outbreak response, and assessment of preventive interventions, these components may be implemented unevenly across territories and may remain insufficiently integrated with health system planning, operational readiness, and economic risk assessment. This technical report proposes an evidence-informed conceptual preparedness framework for dengue in Colombia. The framework was developed through a structured narrative synthesis of peer-reviewed evidence, preparedness-oriented guidance, and Colombia-specific epidemiological, clinical, operational, and health system considerations. It is intended to complement, rather than replace, existing dengue surveillance, prevention, and response strategies by organizing decision points across five interrelated domains: surveillance-to-action, risk-stratified clinical triage, adaptive vector control, contextual vaccination assessment, and healthcare response capacity. A cross-cutting economic risk-mapping component is included to identify relevant cost domains and potential pathways of preventable burden related to outpatient care, hospitalization, productivity loss, outbreak response, severe disease, and healthcare service saturation, without constituting a formal economic evaluation. The framework emphasizes territorial prioritization, timely translation of risk signals into action, early recognition of patients at risk of progression, alignment between community-based interventions and healthcare capacity, and contextual assessment of emerging tools such as tetravalent dengue vaccines and Wolbachia-based vector strategies. It also recognizes implementation constraints, including data interoperability, laboratory and genomic capacity, workforce availability, territorial inequities, financing, pharmacovigilance, governance, and feasibility of local adoption. Future evaluation should assess operational indicators such as signal-to-alert time, triage performance, severe dengue incidence, hospitalization, healthcare resource utilization, stock availability, equity, and cost-effectiveness. In heterogeneous endemic settings, this conceptual framework may support more coordinated dengue preparedness; however, its operational usefulness, economic value, scalability, and policy relevance require stakeholder validation, territorial adaptation, pilot implementation, and prospective evaluation.