Hesitancy and Perceptions Regarding Dengue Vaccination Among Educated Ecuadorians

Background: Global dengue cases have surged in recent years. In Ecuador, reported cases increased from 27,906 in 2023 to 57,712 in 2024. Despite the availability of multiple vaccines in other countries, factors such as socioeconomic disparities, climate change, and vaccine hesitancy continue to hinder prevention efforts. This study aims to analyze the perceptions of the Ecuadorian population and explore possible reasons for hesitancy toward the dengue vaccine. Methods: This cross-sectional observational study was conducted in accordance with the STROBE guidelines. Online surveys, adapted from Kricorian et al., were distributed via the Qualtrics app between June 1st, 2024, and June 25, 2025. Eligible participants were Ecuadorian, at least 18 years old, and had a minimal education level of bachelor. Statistical analysis included descriptive percentages and chi-square tests, with significance set at p < 0.05. Results: A total of 735 participants were included. Most perceived a dengue vaccine as safe (87.2%, n = 641), while 12.8% ( n = 94) considered it unsafe. Overall, 75.9% expressed willingness to be vaccinated. Perceived vaccine safety was significantly associated with vaccination willingness, region of residence, and willingness to vaccinate offspring (all p < 0.001), but not with education level, dengue understanding ( p = 0.747), or prior dengue experience ( p = 0.111). Conclusion: Most Ecuadorians perceive dengue vaccines as safe, yet hesitancy persists. Targeted educational efforts are essential to improve acceptance and coverage.