{ "abstract": "Background: Dengue remains a major public health challenge in hyperendemic regions, where shifts in serotype circulation, spatial transmission patterns, and clinical presentation can significantly influence outbreak dynamics. Colombia has experienced intense dengue activity in recent years; however, integrated analyses combining virological, spatial, and clinical data remain limited. Methods: A retrospective longitudinal observational study was conducted using routinely collected dengue surveillance data from the Department of Meta, Colombia, covering the period from January 2023 to September 2025. Confirmed dengue cases with viral isolation and serotype identification were included. Temporal trends, serotype replacement dynamics, municipal-level spatial redistribution patterns, and clinical characteristics were analyzed using laboratory-confirmed dengue cases. Multivariable logistic regression models were used to identify factors associated with dengue positivity overall and by serotype, while interannual variation was assessed to evaluate changes in transmission intensity and the spatial redistribution of dengue transmission risk. Results: Marked serotype replacement was observed during the study period. DENV-2 predominated during the 2023 peak, followed by a decline and a sustained increase in DENV-3 and DENV-4 by 2025, while DENV-1 disappeared from recent records. Spatial analysis showed declining diagnostic positivity in historically hyperendemic municipalities and significant interannual increases in intermediate municipalities, indicating an epidemiological rebound outside major urban centers. Classical dengue symptoms, including headache, myalgia, and rash, were inversely associated with virological confirmation, whereas nonspecific neurological manifestations, such as somnolence and irritability, emerged as independent predictors. Severe thrombocytopenia remained strongly associated with infection, particularly in DENV-2 cases. Conclusions: The dengue outbreak in Meta (2023–2025) was characterized by dynamic serotype replacement, spatial redistribution of transmission risk, and changing clinical presentations. The rapid emergence of DENV-4 in 2025 serves as an early warning of serotype replacement and underscores the need to update clinical screening protocols to include nonspecific neurological manifestations. Strengthening decentralized laboratory networks and closing surveillance gaps in low-endemicity areas are strategic priorities to improve early detection and outbreak control in hyperendemic regions. Author summary: Dengue is one of the most important mosquito-borne diseases worldwide and remains a major public health challenge in tropical regions. In Colombia, recurrent outbreaks are driven by the circulation of different dengue virus serotypes, which can influence disease transmission patterns and clinical presentation. We analyzed routine surveillance data from the Department of Meta, Colombia, collected between 2023 and September 2025 to investigate changes in serotype circulation, geographic distribution, and clinical characteristics of dengue cases. We found evidence of a rapid replacement of dengue virus serotypes during the outbreak period. DENV-2 predominated during the major epidemic peak in 2023, but its circulation progressively declined while DENV-3 increased and DENV-4 showed a marked rise beginning in 2024 and continuing through 2025, despite its historically limited circulation in the Department of Meta. Spatial analyses also revealed a redistribution of transmission risk from traditionally high-burden municipalities toward intermediate-transmission areas. In addition, some nonspecific neurological manifestations, including somnolence and irritability, emerged as important predictors of laboratory-confirmed dengue infection. These findings provide an early warning of changing dengue epidemiology in Colombia and highlight the importance of strengthening virological surveillance, improving laboratory capacity, and updating clinical screening strategies to support timely outbreak detection and public health response.", "abstract_shown": true, "affiliations": [ "Faculty of Medicine, Universidad Cooperativa de Colombia, Villavicencio, Colombia", "GRIVI, Villavicencio, Colombia", "Laboratorio de Salud Pública, GISSME, Secretaría de Salud del Meta, Villavicencio, Colombia" ], "article_type": "Research Article", "arxiv": null, "author_total": 10, "authors": [ { "affs": [ 0 ], "name": "Liliana Marcela Montilla Rodríguez" }, { "affs": [ 1 ], "name": "Cesar García-Balaguera" }, { "affs": [ 2 ], "name": "Sandra Campo Palacio" }, { "name": "David Bonilla Montes" }, { "name": "Yuri Daniela Cadena Díaz" }, { "name": "Paula Alejandra Mosquera Tocora" }, { "name": "Norma Cristina Pavas Escobar" }, { "name": "Camilo Andrade Carreño" }, { "name": "Elsa Victoria Andrade Miranda" }, { "name": "Marina Sthella Gonzalez Robayo" } ], "bibtex": "https://research.draconitic.com/paper/3hh7mpfr638ke.bib", "cited_by": 0, "doi": "10.1371/journal.pntd.0014733", "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014733", "id": "3hh7mpfr638ke", "issns": [ "1935-2735" ], "landing_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014733", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2739|Mosquito-borne diseases and control" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Flaviviruses/Dengue virus" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/RNA viruses/Flaviviruses/Dengue virus" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Flaviviruses/Dengue virus" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Pain/Myalgia" ], [ "plos", "/Medicine and health sciences/Epidemiology" ], [ "plos", "/Medicine and health sciences/Epidemiology/Disease surveillance/Infectious disease surveillance" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Infectious disease control/Infectious disease surveillance" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Viral diseases/Dengue fever" ], [ "plos", "/Medicine and health sciences/Medical conditions/Tropical diseases/Neglected tropical diseases/Dengue fever" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Flaviviruses/Dengue virus" ], [ "plos", "/Medicine and health sciences/Public and occupational health" ], [ "plos", "/People and places/Geographical locations/South America/Colombia" ] ], "openalex": "W7214367330", "pdf_url": "https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014733&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-25", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/3hh7mpfr638ke.ris", "sources": [ { "first_seen": "2026-10-30T12:17:43Z", "native_id": "10.1371/journal.pntd.0014733", "source": "plos", "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014733" } ], "subjects": [ { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" }, { "field": "medicine", "origin": "plos:infectious diseases", "subfield": "infectious-disease" } ], "title": "Early warning of serotype replacement, spatial risk redistribution, and shifting clinical phenotypes: Insights from the 2023–2025 dengue outbreak in Meta, Colombia", "title_text": "Early warning of serotype replacement, spatial risk redistribution, and shifting clinical phenotypes: Insights from the 2023–2025 dengue outbreak in Meta, Colombia", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:43Z", "url": "https://research.draconitic.com/paper/3hh7mpfr638ke", "venue": "PLOS Neglected Tropical Diseases", "versions": [] }