Integrating national evidence with global standards: China’s updated dengue and chikungunya diagnosis and treatment plans

Abstract China released updated national plans for dengue (2024) and chikungunya (2025) to standardize clinical management amid expanding Aedes -borne risk, recurrent importations with episodic local amplification, and heterogeneous diagnostic capacity. This article synthesizes the clinical and operational content of these documents, situates them within China’s epidemiologic context, and appraises areas of alignment and nuance relative to World Health Organization (WHO) and Pan American Health Organization (PAHO) recommendations. The revised plans recalibrate case stratification and advise against routine corticosteroids/Immunoglobulin therapy(IVIG) for chikungunya. Infection prevention and discharge criteria are operationalized by coupling defervescence with time- and/or virologic-based thresholds. Compared with WHO and PAHO, China converges on core principles—supportive care, early recognition, and judicious fluids management—while adding pragmatic features for arbovirus-endemic settings, notably an explicit dual-testing trigger for febrile arthralgia (simultaneous dengue and chikungunya testing) and more prescriptive discharge and precaution language. Implementation rests on a hub-and-spoke diagnostic model: frontline nonstructural protein 1 antigen testing with reflex Nucleic Acid Amplification Test via prefecture or provincial CDC laboratories, supported by external quality assessments for dengue, chikungunya, and Zika. Domestic evidence strengthens the plans’ real-world clinical applicability: field epidemiology with genotyping demonstrates importation-seeded local transmission; hospital cohorts validate the use of warning-sign–guided escalation, window-based testing, and risk stratification for frail patients; and health-economic analyses inform preseason capacity planning. The remaining gaps are practical rather than conceptual, but they matter because they directly affect patient outcomes and system readiness: pathways for chronic chikungunya arthropathy, pediatric- and pregnancy-specific operational details, tier-appropriate diagnostic turnaround standards, and numeric thresholds linked to time-bound escalation. Overall, China’s 2024–2025 plans harmonize with international norms while translating them into implementable routines for mixed-transmission environments, offering a replicable model for regions facing overlapping arboviral threats.